Table 3.

NCCN recommendations for follow-up therapy if not meeting a defined milestone.^10,34

Follow-up period	Response	NCCN recommendationa
3 months	BCR-ABL1 transcripts >10% or lack of PCyRb	Primary treatment: Imatinib: Switch to alternate TKI or, if alternate is not possible, escalate imatinib dose to ≤800 mg, as toleratedc
		Dasatinib/nilotinib: Continue or switch to alternate TKI (other than imatinib)
6 months	BCR-ABL1 transcripts >10% or lack of PCyR	Switch to alternate TKI (other than imatinib)c,d
	PCyR or BCR-ABL1 transcripts ≤10%, but >1% (IS)	Continue or switch to alternate TKI (other than imatinib), or if alternate TKI or omacetaxined are not possible, escalate imatinib dose to ≤800 mg, as tolerated
12 months	<PCyR or BCR-ABL1 transcripts >10% (IS)	Switch to alternate TKI (other than imatinib)c,d
	Cytogenetic relapse	Switch to alternate TKI (other than imatinib), or if alternate TKI or omacetaxined are not possible, escalate imatinib dose to ≤800 mg, as toleratedc

IS: International Scale; NCCN: National Comprehensive Cancer Network; PCyR: partial cytogenetic response; TKI: tyrosine kinase inhibitor.

^aIf response milestones are not being achieved, please evaluate patient adherence and BCR-ABL1 mutation status.

^bBone marrow cytogenetics identifies 1%–35% of cells with a Ph chromosome.

^cEvaluation for an allogenic hematopoietic cell transplant or enrollment in a clinical trial are additional options.

^dOmacetaxine is a treatment option for patients who are intolerant of or not responding to two or more TKIs.