Accelerated And Blastphase

The follow-up of patients with advanced CML depends largely on whether or not they are HSCT candidates. Although some patients with accelerated-phase CML can achieve relatively durable remissions (see Chapter 19), cure is unlikely, and progression is often rapid. Thus, patients with advanced CML should be considered for HSCT even if they respond favorably to ima-tinib therapy.

Not all patients are transplant candidates, however, and these patients will need to be monitored for evidence of progressive disease. Dose escalation of imatinib is a viable treatment option for patients progressing on standard doses. Whether combinations of imatinib with other active agents will prove beneficial is uncertain, but participation in clinical trials is recommended.

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