CML TEST PAPER QUESTIONS AND SOLUTIONS 2025/2026
ALL GRADED A+
✔✔CML -Treatment History - ✔✔Splenic Irradiation: 1920 -1950
Busulfan: 1950 - 1960
Hydroxyurea: 1960 - 1970
1st Allogeneic Stem Cell Transplant for CML 1979 - Present
1. High mortality risk
2. Matched donor
3. Age
IFN-alfa: 1980 - 1990
IFN-alfa + Cytosine Arabinoside (Ara-C): 1990 - 2001
Tyrosine Kinase (TK) Inhibitors: 2001 - Present
✔✔CML -Treatment History: What is the standard? - ✔✔Standard of treatment, gleevac
is still gold standard
✔✔CML Chronic Phase Treatment Drugs - ✔✔Initial treatment: Hydroxyurea?
Gold Standard:
Imatinib Mesylate (Gleevec®)
✔✔CML Chronic Phase Treatment Goals: - ✔✔1. Prolong survival
Goal is not necessarily to cure, but if we do great
2. Does allogeneic stem cell transplant = cure?
✔✔CML Peripheral Blood Stem Cell Transplant - ✔✔Survival of Adult Patients by
Disease Stage 2000 - 2009
Lack of major effect took transplant off table in general
✔✔CML Chronic Phase Treatment: Drugs - ✔✔Imatinib 400 mg po daily
Nilotinib 300 mg po BID
Dasatinib 100 mg po daily
All category 1 recommendations from NCCN
After initiating therapy with imatinib (or like agent), the WBC should begin to fall within
the first two weeks
Should clear these cells within about a month, can use hydroxyurea to cyto reduce,
don't need to though
WBC usually normalizes within 4 to 6 weeks
, Kaplan-Meier Estimates of the Cumulative Best Response to Initial Imatinib Therapy
✔✔Does imatinib have potential to cure people with cml? - ✔✔Answer is yes in a small
% of patients with a complete molecular response and leukemia stem cell dies off for
some reason,
Usually happens after 5 years,
Follow with bone marrow biopsies every 3 months to see if still in remission, Generally
need to take imatinib for life though
✔✔Additional CML Treatment Options: The Drugs - ✔✔Imatinib
Dasatinib
Nilotinib
Bosutinib
Omacetaxine
Ponatinib
✔✔Additional CML Treatment Options: The First Line Drugs - ✔✔Imatinib
Dasatinib
Nilotinib
✔✔Additional CML Treatment Options: Imatinib - ✔✔400 mg PO BID
(if no resistance)
FDA-approved 2001
✔✔Additional CML Treatment Options: Dasatinib - ✔✔100 mg PO Daily
FDA-approved July 2006
Src & Bcr-Abl TK inhibitor
✔✔Additional CML Treatment Options: Nilotinib - ✔✔300 mg PO BID
FDA-approved: June 2007
✔✔Additional CML Treatment Options: Bosutinib - ✔✔500 mg PO Daily
FDA-approved: September 2012
✔✔Additional CML Treatment Options: Omacetaxine - ✔✔FDA-approved: October 2012
An injectable BID for 2 weeks of every month,
Not the best when others are oral
✔✔Additional CML Treatment Options: Ponatinib - ✔✔FDA-approved: December 2012
FDA-disapproved: October 2013
Showed a high rate of arterial thrombosis, was looking like it was going to be a first line
agent, but then got pulled.
ALL GRADED A+
✔✔CML -Treatment History - ✔✔Splenic Irradiation: 1920 -1950
Busulfan: 1950 - 1960
Hydroxyurea: 1960 - 1970
1st Allogeneic Stem Cell Transplant for CML 1979 - Present
1. High mortality risk
2. Matched donor
3. Age
IFN-alfa: 1980 - 1990
IFN-alfa + Cytosine Arabinoside (Ara-C): 1990 - 2001
Tyrosine Kinase (TK) Inhibitors: 2001 - Present
✔✔CML -Treatment History: What is the standard? - ✔✔Standard of treatment, gleevac
is still gold standard
✔✔CML Chronic Phase Treatment Drugs - ✔✔Initial treatment: Hydroxyurea?
Gold Standard:
Imatinib Mesylate (Gleevec®)
✔✔CML Chronic Phase Treatment Goals: - ✔✔1. Prolong survival
Goal is not necessarily to cure, but if we do great
2. Does allogeneic stem cell transplant = cure?
✔✔CML Peripheral Blood Stem Cell Transplant - ✔✔Survival of Adult Patients by
Disease Stage 2000 - 2009
Lack of major effect took transplant off table in general
✔✔CML Chronic Phase Treatment: Drugs - ✔✔Imatinib 400 mg po daily
Nilotinib 300 mg po BID
Dasatinib 100 mg po daily
All category 1 recommendations from NCCN
After initiating therapy with imatinib (or like agent), the WBC should begin to fall within
the first two weeks
Should clear these cells within about a month, can use hydroxyurea to cyto reduce,
don't need to though
WBC usually normalizes within 4 to 6 weeks
, Kaplan-Meier Estimates of the Cumulative Best Response to Initial Imatinib Therapy
✔✔Does imatinib have potential to cure people with cml? - ✔✔Answer is yes in a small
% of patients with a complete molecular response and leukemia stem cell dies off for
some reason,
Usually happens after 5 years,
Follow with bone marrow biopsies every 3 months to see if still in remission, Generally
need to take imatinib for life though
✔✔Additional CML Treatment Options: The Drugs - ✔✔Imatinib
Dasatinib
Nilotinib
Bosutinib
Omacetaxine
Ponatinib
✔✔Additional CML Treatment Options: The First Line Drugs - ✔✔Imatinib
Dasatinib
Nilotinib
✔✔Additional CML Treatment Options: Imatinib - ✔✔400 mg PO BID
(if no resistance)
FDA-approved 2001
✔✔Additional CML Treatment Options: Dasatinib - ✔✔100 mg PO Daily
FDA-approved July 2006
Src & Bcr-Abl TK inhibitor
✔✔Additional CML Treatment Options: Nilotinib - ✔✔300 mg PO BID
FDA-approved: June 2007
✔✔Additional CML Treatment Options: Bosutinib - ✔✔500 mg PO Daily
FDA-approved: September 2012
✔✔Additional CML Treatment Options: Omacetaxine - ✔✔FDA-approved: October 2012
An injectable BID for 2 weeks of every month,
Not the best when others are oral
✔✔Additional CML Treatment Options: Ponatinib - ✔✔FDA-approved: December 2012
FDA-disapproved: October 2013
Showed a high rate of arterial thrombosis, was looking like it was going to be a first line
agent, but then got pulled.
