A 66-year-old man presents with fatigue, night sweats, and splenomegaly. Blood counts show WBC 210,000/µL with a left shift, basophilia 8%, eosinophilia, normocytic anaemia, and platelets 650,000/µL. Cytogenetics reveal t(9;22). The BCR-ABL1 fusion creates an abnormal tyrosine kinase with constitutive activity. The first-line treatment according to current ELN 2020 guidelines is:
- A Hydroxyurea alone as definitive therapy
- B Allogeneic stem cell transplant as first-line
- C Imatinib 400 mg/day or a second-generation TKI (nilotinib/dasatinib) based on risk score ✓
- D Interferon-alpha monotherapy
Correct answer: C. Imatinib 400 mg/day or a second-generation TKI (nilotinib/dasatinib) based on risk score
Explanation
Chronic myeloid leukaemia (CML) in chronic phase is treated with BCR-ABL1 tyrosine kinase inhibitors (TKIs) as first-line. ELN 2020 guidelines allow imatinib 400 mg/day for low-risk patients or second-generation TKIs (nilotinib, dasatinib, bosutinib) for intermediate/high-risk patients and those with specific co-morbidity profiles. Second-generation TKIs achieve deeper and faster molecular responses. Hydroxyurea is used only for cytoreduction. Allogeneic SCT is reserved for advanced phase or TKI failure. Interferon is an old, inferior option.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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