A 72-year-old man presents with fatigue, night sweats, and splenomegaly. CBC shows WBC 280,000/µL with myeloid predominance across all stages, basophilia, and a Philadelphia chromosome on cytogenetics. He is treatment-naive. According to current guidelines, the first-line treatment is:
- A Imatinib 400 mg/day
- B Asciminib 40 mg BD
- C Dasatinib 100 mg/day or nilotinib 300 mg BD as preferred options ✓
- D Hydroxyurea cytoreduction then allogeneic stem cell transplantation
Correct answer: C. Dasatinib 100 mg/day or nilotinib 300 mg BD as preferred options
Explanation
For newly diagnosed CML in chronic phase, ELN 2020 guidelines recommend any of imatinib, dasatinib, nilotinib, or bosutinib as first-line options. Dasatinib 100 mg/day and nilotinib 300 mg BD are second-generation TKIs that achieve faster and deeper molecular responses (MMR by 12 months) than imatinib in major trials (DASISION, ENESTnd), making them preferred when treatment-free remission is a goal. Asciminib is currently approved for third-line or T315I mutation. Upfront allogeneic SCT is not first-line.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.