Proposed approach to monitoring CML
| 1. At diagnosis |
| CG: part of marrow evaluation; detects clonal evolution |
| FISH: detects Ph-negative BCR-ABL–positive disease; detects deletions of derivative chromosome 9; also if further follow up before CGCR by FISH |
| QPCR: only if subsequent monitoring is based solely on QPCR |
| 2. On therapy until cytogenetic complete remission (or equivalent disease level) |
| CG: every 3–6 months |
| FISH: alternative to CG; every 3 months |
| QPCR: alternative to CG; every 3 months |
| 3. Documentation of cytogenetic complete remission |
| CG: FISH alternative to CG; QPCR as baseline for subsequent comparisons |
| 4. Following attainment of cytogenetic complete remission |
| CG: every 12–24 mo |
| FISH: alternative to CG; every 6 mo |
| QPCR: alternative to CG or FISH; every 3–6 mo |
| 5. At time of suspected resistance/relapse (cytogenetic or hematologic) |
| Repeat CG |
| QPCR |
| Mutational studies to direct choice of subsequent therapy |
| 1. At diagnosis |
| CG: part of marrow evaluation; detects clonal evolution |
| FISH: detects Ph-negative BCR-ABL–positive disease; detects deletions of derivative chromosome 9; also if further follow up before CGCR by FISH |
| QPCR: only if subsequent monitoring is based solely on QPCR |
| 2. On therapy until cytogenetic complete remission (or equivalent disease level) |
| CG: every 3–6 months |
| FISH: alternative to CG; every 3 months |
| QPCR: alternative to CG; every 3 months |
| 3. Documentation of cytogenetic complete remission |
| CG: FISH alternative to CG; QPCR as baseline for subsequent comparisons |
| 4. Following attainment of cytogenetic complete remission |
| CG: every 12–24 mo |
| FISH: alternative to CG; every 6 mo |
| QPCR: alternative to CG or FISH; every 3–6 mo |
| 5. At time of suspected resistance/relapse (cytogenetic or hematologic) |
| Repeat CG |
| QPCR |
| Mutational studies to direct choice of subsequent therapy |
CG indicates cytogenetics; and CGCR, complete CG response.