The BCR-ABL1 fusion gene in chronic myeloid leukaemia (CML) results from the translocation t(9;22). The preferred FIRST-LINE tyrosine kinase inhibitor for newly diagnosed chronic-phase CML with SOKAL high-risk score and desire for treatment-free remission is:
- A Nilotinib or dasatinib (second-generation TKI) for deeper and faster molecular responses ✓
- B Imatinib 400 mg daily
- C Ponatinib as it covers T315I mutation upfront
- D Interferon-alpha as it can induce durable remissions
Correct answer: A. Nilotinib or dasatinib (second-generation TKI) for deeper and faster molecular responses
Explanation
Second-generation TKIs (nilotinib and dasatinib) achieve deeper molecular responses (MR4.5, defined as BCR-ABL1 ≤0.0032% IS) faster than imatinib, which is a prerequisite for attempting treatment-free remission (TFR). In a high-Sokal-risk patient where achieving TFR is a goal, second-generation TKIs are preferred upfront per ELN 2020 recommendations. Ponatinib is reserved for T315I mutation or failure of ≥2 prior TKIs due to toxicity. Interferon has been superseded by TKIs.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.