Second-generation tyrosine kinase inhibitors in chronic myeloid leukemia today: efficacy and safety

The prognosis of chronic myeloid leukemia (CML) has changed during the past two decades from a disease with an overall survival of 5 years only to one in which patients can enjoy a near normal life-expectancy. Such remarkable improvement in the patients’ outcome is mainly due to the introduction of imatinib into the clinic (the first approved tyrosine kinase inhibitor TKI), but also to the approvals of others TKIs. Currently, there are six TKIs available for CML treatment in clinical practice. The article discusses the effectiveness and safety of only the 2nd generation of ITCs, each of which has its own range of both adverse events and advantages when prescribed in the first or subsequent lines of CML therapy. Although a proportion of patients (around 25%) will be able to successfully discontinue TKI treatment after achieving a deep molecular remission, most of them will require to keep on treatment indefinitely. In such a situation, it is crucial for doctors caring for CML patients to be aware of which TKIs are available for each particular clinical situation, what can be expected from them, and how to manage their potential side effects. In the present review, we will briefly address these issues from a practical point of view.