A 70-year-old man presents with fatigue and splenomegaly. CBC shows WBC 80,000/µL with a left shift (many myelocytes and metamyelocytes), Hb 10 g/dL, platelets 650,000/µL. BCR-ABL1 fusion transcript (p210) is detected by RT-PCR. He is in chronic phase CML. Per ELN guidelines, first-line treatment is:

• A Hydroxyurea indefinitely for cytoreduction
• B Imatinib 400 mg daily or a second-generation TKI (dasatinib/nilotinib) ✓
• C Allogeneic stem cell transplantation immediately
• D Interferon-alpha plus cytarabine

Explanation

Chronic-phase CML is treated with tyrosine kinase inhibitors (TKIs) targeting BCR-ABL1 as first-line therapy. Imatinib 400 mg daily achieves major molecular response in ~60% at 12 months; second-generation TKIs (dasatinib, nilotinib, bosutinib) produce faster and deeper responses and are also first-line options, particularly for higher-risk patients. Allogeneic SCT is now reserved for blast phase or TKI-resistant disease. Hydroxyurea is only for temporary cytoreduction.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.