Reply to A. Jiménez-Velasco et al

Abstract

We appreciate the interest of Jimenez-Velasco et al in the newly revised edition of the European LeukemiaNet chronic myeloid leukemia (CML) recommendations. They noticed we recommended performing the first cytogenetic test at 3 months, and in the case of no cytogenetic response (Ph 95%) we defined the response as suboptimal. In the case of at least a minor cytogenetic response (Ph 65), we defined the response as optimal, but we did not make any recommendation for minimal cytogenetic response (Ph 66% to 95%). As also reported by Jimenez-Velasco et al in their letter, the data pertaining to the prognostic value of the cytogenetic response at 3 months are limited. We reviewed the studies already published, and we also considered some unpublished data from the GIMEMA CML Study Group. We believe that although it is possible to attribute a suboptimal value to the minimal cytogenetic response, the data were insufficient to validate this recommendation. In conclusion, it was possible to express a clinically and therapeutically relevant recommendation either for Ph less than 65% (optimal) or Ph more than 95% (suboptimal), but not for Ph 66% to 95%. In such cases, the current recommendation is to continue the treatment, even if the response does not fit the definition of optimal.