How I treat pediatric chronic myeloid leukemia.
10.7499/j.issn.1008-8830.2503021
- Author:
Wen-Bin AN
1
;
Wen-Yu YANG
1
Author Information
1. State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300020, China.
- Publication Type:English Abstract
- Keywords:
Allogeneic hematopoietic stem cell transplantation;
Child;
Chronic myeloid leukemia;
Diagnosis;
Treatment;
Tyrosine kinase inhibitor
- MeSH:
Humans;
Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy*;
Child;
Hematopoietic Stem Cell Transplantation;
Protein Kinase Inhibitors/therapeutic use*;
Male;
Female;
Adolescent
- From:
Chinese Journal of Contemporary Pediatrics
2025;27(7):792-801
- CountryChina
- Language:Chinese
-
Abstract:
Pediatric chronic myeloid leukemia (CML) is more aggressive than adult CML, with unique molecular characteristics and a higher propensity for lymphoid blast crisis. The application of tyrosine kinase inhibitors (TKIs) has significantly improved the prognosis of pediatric CML. Based on international consensus and clinical experience, this article proposes standardized diagnosis and treatment recommendations for pediatric CML, covering initial therapy selection, efficacy evaluation, drug switching, and management of adverse effects. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is recommended only for patients with disease progression or failure of multiple lines of TKI therapy. For children newly diagnosed with CML in accelerated phase, high-dose imatinib or second-generation TKIs are recommended as first-line therapy. Those achieving optimal responses should continue maintenance therapy, while non-responders require switching to alternative TKIs and consider allo-HSCT. For blast-phase CML, induction therapy requires a combination of TKIs and chemotherapy, with allo-HSCT serving as the core curative intervention. This article highlights common but challenging problems (poor response, drug intolerance, and disease progression) in pediatric CML treatment using three typical cases, aiming to optimize treatment strategies. Furthermore, the goal of achieving treatment-free remission needs to be further addressed through multi-center clinical studies.
