Abstract
Despite the dramatic success seen with tyrosine kinase inhibitors (TKIs) in most patients with chronic myeloid leukemia (CML), some patients still develop resistance or intolerance and need alternative therapies. Monitoring response to TKI therapy via hematologic, cytogenetic, and molecular analysis is a critical component of managing CML. Thus, uniform response definitions, response criteria, and monitoring recommendations have been developed to aid in early recognition of resistance to TKI therapy, allowing timely changes in management strategy. However, differences exist between these recommendations, and questions regarding how best to assess response, including how to define treatment failure and how monitoring should be conducted, remain. Several new drugs in late-stage development may help overcome resistance and provide additional options for patients with CML. As members of a coordinated multidisciplinary care team, advanced practitioners play a key role in the management of CML. Key to this process are incorporation of strategies to improve outcome by addressing nonadherence, managing side effects, and addressing other factors that can contribute to resistance. Along with improved survival with TKI therapy, family planning has become an important aspect of patient management. By providing education and support, advanced practitioners can assist patients and their partners in navigating this challenging situation.
