A 45-year-old woman is diagnosed with chronic myeloid leukaemia (CML) in chronic phase. BCR-ABL transcript is detected. She has no prior TKI treatment. Sokal score is intermediate. Which FIRST-LINE treatment is preferred per current guidelines?

• A Allogeneic stem cell transplant upfront
• B Hydroxyurea for cytoreduction then watch
• C Interferon-alpha based therapy
• D Imatinib or second-generation TKI (nilotinib/dasatinib) ✓

Explanation

Tyrosine kinase inhibitor (TKI) therapy is the standard first-line treatment for CML chronic phase; imatinib (first-generation) achieves durable responses, while second-generation TKIs (nilotinib, dasatinib) achieve deeper/faster molecular responses and may be preferred for intermediate/high Sokal risk. Allogeneic transplant is reserved for blast phase or TKI-resistant/intolerant cases. Hydroxyurea is only used for short-term cytoreduction. Interferon-based therapy has been largely replaced by TKIs.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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