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BCR-ABL1 as the target and the monitor — adherence is half the treatment
Chronic myeloid leukemia (CML) is defined by the Philadelphia chromosome and the BCR-ABL1 fusion gene. Tyrosine kinase inhibitors (TKIs) have transformed the disease into a long-term condition for most patients. Response is assessed by blood counts and quantitative BCR-ABL1 transcript levels at defined milestones, and treatment is adjusted for intolerance, resistance or loss of response.
Haematology & Haemato-Oncology
Authored and reviewed by Dr. Sachita Baniya (MBBS, FCPS (Clinical Haematology), NMC 20158). Evidence-based, no fabricated outcomes.
Chronic myeloid leukemia (CML) is defined by the Philadelphia chromosome and the BCR-ABL1 fusion gene. Tyrosine kinase inhibitors (TKIs) have transformed the disease into a long-term condition for most patients. Response is assessed by blood counts and quantitative BCR-ABL1 transcript levels at defined milestones, and treatment is adjusted for intolerance, resistance or loss of response.
Reviewed by Dr. Sachita Baniya, MBBS, FCPS — Consultant Haemato-Oncologist & Clinical Hematologist (NMC 20158). For evaluation, contact the respective hospital or cancer centre — Kathmandu Cancer Center (KCC) Nepal, Civil Service Hospital Kathmandu, or Advanced Care Hospital.
CML is suspected with leukocytosis, basophilia and a left shift. Diagnosis is confirmed by cytogenetics showing t(9;22) or by a molecular test for BCR-ABL1. Baseline risk scores, blood counts, organ function, pregnancy plans and comorbidity are reviewed before selecting a TKI. Bone marrow examination is not always required but helps in atypical presentations.
BCR-ABL1 transcript levels are checked at defined intervals after starting therapy. Milestone responses guide whether to continue, increase intensity, switch TKI or investigate resistance. Adherence and tolerability are reviewed at every visit. Some patients with sustained deep molecular response may be considered for treatment-free remission under close supervision, but this is never done outside a monitoring protocol.
Guidelines referenced:
European LeukemiaNet recommendations for managing CMLNCCN Guidelines — Chronic Myeloid LeukemiaWHO Classification of Haematopoietic and Lymphoid TumoursContent on this website is for general educational purposes only and does not constitute medical advice, diagnosis, or treatment. It is not a substitute for evaluation by a qualified healthcare professional. Always seek the advice of your physician or other qualified provider with any questions regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read on this website. In case of a medical emergency, contact emergency services immediately. No doctor–patient relationship is established by use of this site or by contacting the clinic through the site.