Korean Guidelines for Treating Chronic Myelogenous Leukemia - The Korean Society of Hematology Chronic Myelogenous Leukemia Working Party

Kim, Dae-Young; Lee, Jeong-Ok; Kim, Kyung-Ha; Kim, Byung Soo; Kim, Sung Hyun; Kim, Yeo-Kyeoung; Kim, Hyeoung-Joon; Kim, Inho; Park, Seonyang; Park, Joon Seong; Chung, Joo-Seop; Cheong, June-Won; Jung, Chul Won; Jo, Deog-Yeon; Sohn, Sang Kyun; the Korean Society of Hematology, Chronic Myelogenous Leukemia Working Party,

doi:2015.88.4.406

Korean J Med > Volume 88(4); 2015 > Article

Original Article

The Korean Journal of Medicine 2015;88(4):406-419.
Published online April 1, 2015.
DOI: https://doi.org/10.3904/kjm.2015.88.4.406

Korean Guidelines for Treating Chronic Myelogenous Leukemia - The Korean Society of Hematology Chronic Myelogenous Leukemia Working Party

Dae-Young Kim¹, Jeong-Ok Lee², Kyung-Ha Kim³, Byung Soo Kim⁴, Sung Hyun Kim⁵, Yeo-Kyeoung Kim⁶, Hyeoung-Joon Kim⁶, Inho Kim⁷, Seonyang Park⁷, Joon Seong Park⁸, Joo-Seop Chung⁹, June-Won Cheong¹⁰, Chul Won Jung¹¹, Deog-Yeon Jo¹², Sang Kyun Sohn¹³, Chronic Myelogenous Leukemia Working Party, the Korean Society of Hematology

¹Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
²Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
³Department of Oncology and Hematology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Korea
⁴Division of Oncology and Hematology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
⁵Division of Hematology and Oncology, Department of Internal Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
⁶Department of Hematology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, Korea
⁷Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
⁸Department of Hematology-Oncology, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Korea
⁹Department of Hemato-oncology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
¹⁰Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Korea
¹¹Division of Hematology and Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
¹²Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
¹³Department of Hemato-Oncology, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea

만성골수성백혈병 한국 치료 가이드라인-대한혈액학회

김대영¹, 이정옥², 김경하³, 김병수⁴, 김성현⁵, 김여경⁶, 김형준⁶, 김인호⁷, 박선양⁷, 박준성⁸, 정주섭⁹, 정준원¹⁰, 정철원¹¹, 조덕연¹², 손상균¹³, 대한혈액학회 만성골수성백혈병연구회

^¹울산대학교 의과대학 서울아산병원 혈액내과
^²서울대학교 의과대학 분당서울대학교병원 혈액종양내과
^³순천향대학교 의과대학 순천향대학교서울병원 종양혈액내과
^⁴고려대학교 의과대학 고려대학교안암병원 종양혈액내과
^⁵동아대학교 의과대학 동아대학교병원 혈액종양내과
^⁶전남대학교 의과대학 화순전남대학교병원 혈액내과
^⁷서울대학교 의과대학 서울대학교병원 내과
^⁸아주대학교 의과대학 아주대학교의료원 종양혈액내과
^⁹부산대학교 의학전문대학원 부산대학교병원 혈액종양내과
^¹⁰연세대학교 의과대학 혈액내과학교실
^¹¹성균관대학교 의과대학 삼성서울병원 혈액종양내과
^¹²충남대학교 의과대학 내과학교실
^¹³경북대학교 의과대학 경북대학교병원 혈액종양내과

Correspondence:
Sang Kyun Sohn, Tel: +82-53-420-5587, Fax: +82-53-426-2046, Email: sksohn@knu.ac.kr

Received: 17 February 2014 • Revised: 7 April 2014 • Accepted: 5 May 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims
The first edition of the Korean treatment guidelines for chronic myelogenous leukemia (CML) was published in 2006. We intend to update those guidelines to include the use of next-generation tyrosine kinase inhibitors (TKIs).
Methods
New guidelines were developed in 2012 based on the results of a survey and a consensus meeting of various Korean experts, the reports of recent clinical studies, and updated guidelines from external study groups.
Results
An assessment of risk factors is strongly recommended before treating newly diagnosed chronic phase CML. Imatinib, dasatinib, and nilotinib are reimbursable in Korea as first-line treatments, and the patient’s age, comorbidities, and possible adverse events should be considered in the choice of treatment. Molecular studies are recommended for assessing treatment efficacy instead of invasive cytogenetic response evaluations, and an early response is believed to correlate with a good prognosis. Second-line TKIs can be considered for patients who fail or are intolerant of first-line therapy, pending analysis of ABL tyrosine kinase mutation status. For treating advanced stages, a combination of TKIs with cytotoxic agents and hematopoietic cell transplantation is recommended. The adverse effects of TKI therapy can be managed via dose reduction and supportive care, or switching to an alternate TKI.
Conclusions
The use of TKIs has improved the outcome of CML treatment. Treatment-free remission after discontinuing TKIs might be possible in select patients who achieve sufficient response, indicating that curative treatment for CML can be expected in the future.

Key Words: Leukemia, chronic myelogenous; Protein-tyrosine kinases; Guideline

주제어: 만성골수성백혈병, 티로신키나제억제제, 진단 및 치료 지침