Michael Mauro, MD, Talks ELN/NCCN Recommendations for Patients With CML

At the virtual Great Debates & Updates in Hematologic Malignancies, Michael Mauro, MD, Memorial Sloan Kettering Cancer Center, New York, presented on practical approaches for monitoring patients with chronic myeloid leukemia (CML) as per the recommendations by the National Comprehensive Cancer Network (NCCN) and the European LeukemiaNet (ELN).

Here, we focus on the what these guidelines state with regard to the initial evaluation of a patient with CML.

NCCN Recommendations

According to the NCCN guidelines, during the initial evaluation of a patient with CML, bone marrow studies are still warranted, with bone marrow aspirate and biopsies recommended for morphologic review and cytogenetic evaluation. Baseline PCr testing is also recommended.

“We really gage a lot of our assessment of patient improvement based on their PCr, and it’s not just how they met an arbitrary milestone, it’s also coupled with how they met a reduction that’s relevant to their initial baseline,” Dr Mauro said.

He also addressed the scoring system, which have been updated by the NCCN and recommended for consideration; this scoring system includes the Sokal score, Hansford (EURO) score, and the EUTOS Long-Term Survival (ELTS) score.

ELN Recommendations

As per the ELN guidelines, bone marrow studies are also recommended during initial evaluations. Baseline PCr testing is also recommended, but not just to quantify but to also reveal the transcript type which may be of some importance.

“There have been some recent studies showing that amongst the p210 types, e13 and e14, there may be some differences in response and outcome, and even treatment-free remission, so identifying the transcript type is important,” Dr Mauro told listeners.

Electrocardiograms and scoring systems (eg, ELTS score) are also recommended by the ELN.

Guidelines Defined

“The word ‘guideline’ has become a buzzword. Not only in the field of hematology and leukemia, but across the world and, perhaps most importantly, in the United States,” explained Dr Mauro.

Citing the Oxford English Dictionary definition of guidelines, which states that a guideline is a general rule, principle, or piece of advice, Dr Mauro told attendees that guidelines are not laws, but often hailed in similar high regard.

“Guidelines give advice as to behavior, action where uncertainty or unfamiliarity exists, and/or where precise, careful decision-making is crucial,” he said, adding that guidelines should be evidence-based and established as per best available data.

“I would say we should aim to try to follow guidelines unless we have a better idea, and if you have a better idea, you should let the people who write the guidelines know so they can incorporate that if it is relevant. Guidelines are good,” he concluded.—Hina M. Porcelli

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