The definition of response to first-line treatment, as proposed by the panel, when TFR is the primary goal
| . | Optimal . | Nonoptimal . | Failure/resistance . |
|---|---|---|---|
| Continue the same TKI | Switching to another TKI is optional | Changing the TKI is mandatory | |
| 3 mo | CHR, and BCR-ABL1 ≤10, or BCR-ABL1 >10, not confirmed | NA | No CHR, or BCR-ABL1 >10, confirmed |
| 6 mo | BCR-ABL1 ≤1 | BCR-ABL >1-10 | BCR-ABL1 >10 |
| 12 mo | BCR-ABL1 ≤0.1 | BCR-ABL1 >0.1-1 | BCR-ABL1 >1 |
| 24 mo | BCR-ABL1 ≤0.01 | BCR-ABL1 >0.01-0.1 | BCR-ABL1 >0.1 or an increase of BCR-ABL1 of at least 1 log or a mutation |
| . | Optimal . | Nonoptimal . | Failure/resistance . |
|---|---|---|---|
| Continue the same TKI | Switching to another TKI is optional | Changing the TKI is mandatory | |
| 3 mo | CHR, and BCR-ABL1 ≤10, or BCR-ABL1 >10, not confirmed | NA | No CHR, or BCR-ABL1 >10, confirmed |
| 6 mo | BCR-ABL1 ≤1 | BCR-ABL >1-10 | BCR-ABL1 >10 |
| 12 mo | BCR-ABL1 ≤0.1 | BCR-ABL1 >0.1-1 | BCR-ABL1 >1 |
| 24 mo | BCR-ABL1 ≤0.01 | BCR-ABL1 >0.01-0.1 | BCR-ABL1 >0.1 or an increase of BCR-ABL1 of at least 1 log or a mutation |
If the BCR-ABL1 level at 3 months is >10%, the qPCR must be repeated immediately. If it decreases to <10%, the response becomes optimal; if it remains >10%, the response becomes a failure. Notice that a more precise definition of the molecular response at 3 months is not only beneficial for the patients, but is also cost-effective because the cost of an extra qPCR is fully covered by the differences in cost between imatinib and 2GTKIs.
CHR, complete hematological response; NA, not applicable.