There have been no studies that demonstrate that followup with BCR/ABL assists with actual clinical management of CML but it has become standard based on a guideline recommendation.It is not clear what the best monitoring stategy of imatinib might be; however, bcr/abl analysis would be a part of any finally accepted strategy. Unfortunately no trials of such strategies have been eprfomred but there is guidance from expert consensus. Some physicians get regular bcr/abl transcripts, others use FISH, others only use it for monitoring when Ph chromosome is undetectable. As noted, NCCN expresses the expert consensus and recommends BCR/ABL transcript analysis every three months until complete cytogenic response is reached and every 3-6 months thereafter.
Baccarani M, Pane F, Saglio G. Monitoring treatment of chronic myeloid leukemia. Haematologica. 2008;93:161–169.
Laboratory practice guidelines for detecting and reporting BCR-ABL drug resistance mutations in chronic myelogenous leukemia and acute lymphoblastic leukemia: a report of the Association for Molecular Pathology.
Jones D, Kamel-Reid S, Bahler D, Dong H, Elenitoba-Johnson K, Press R, Quigley N, Rothberg P, Sabath D, Viswanatha D, Weck K, Zehnder J.
J Mol Diagn. 2009 Jan;11(1):4-11. doi: 10.2353/jmoldx.2009.080095. Epub 2008 Dec 18.
Gluckman, J. Reiffers, et al. Imatinib mesylate discontinuation in patients with chronic myelogenous leukemia in complete molecular remission for more than 2 years. Blood, January 1, 2007; 109(1): 58 – 60.
J. V. Melo, T. P. Hughes, and J. F. Apperley. Chronic Myeloid Leukemia. Hematology, January 1, 2003; 2003(1): 132 – 152.
Hematology Disease Site Group. Walker I, Makarski J, Stevens A, Meyer RM. Treatment of chronic myeloid leukemia with imatinib. Toronto (ON): Cancer Care Ontario (CCO); 2004 Jul 16. 27 p. (Practice guideline report; no. 6-15). [39 references]