A personalized approach to choose wisely treatment for a CML patient in 2019 should be applied.
Disease severity according to established risk scores combined with patient's characteristics – mainly age and comorbidities (primarily cardiovascular) as well as personal aims and wishes should guide the choice of treatment.
In my talk I will focus on an age adjusted personalized approach based on these parameters as a platform.
Adolescent and young adult (AYA) patients pose special challenges including: lack of specific recommendations, paucity of clinical trials with conflicting outcomes, inferior results compared to adults, an urgent need for fast achievement of sustained deep molecular response for the sake of pregnancy and cure, perfect adherence to treatment as a goal and hurdle, high quality of life hampered by side effects and allogeneic stem cell transplantation as a realistic option
Older patients with cardiovascular comorbidities pose other challenges.
A strong association between peripheral arterial occlusive disease, cardiovascular risk factors and nilotinib has been reported. Thus in patients taking nilotinib, a rigorous control of these risk factors should be adopted.
The most notorious TKI with this respect is ponatinib. Since there is direct relationship between ponatinib dose and arterial occlusive events, dose adjustments should be carried out.
Finally, by integrating the CML prognostic scores with cardiovascular risk scores, specific personalized recommendations can be applied for each CML patient in 2019.