Leukaemia (chronic myeloid) - imatinib
Guidance on the use of imatinib for chronic myeloid leukaemia (TA70)
1. Guidance
NOTE: This guidance replaces Technology Appraisal Guidance No. 50 issued in September 2002.
The Institute reviews each piece of guidance it issues.
The review and re-appraisal of the use of imatinib for chronic myeloid leukaemia has resulted in a change in the guidance. Specifically:
- imatinib is recommended as first-line treatment for people with Philadelphia-chromosome-positive chronic myeloid leukaemia (CML) in the chronic phase.
1.1. Imatinib is recommended as first-line treatment for people with Philadelphia-chromosome-positive chronic myeloid leukaemia (CML) in the chronic phase.
1.2. Imatinib is recommended as an option for the treatment of people with Philadelphia-chromosome-positive CML who initially present in the accelerated phase or with blast crisis. Additionally, imatinib is recommended as an option for people who present in the chronic phase and then progress to the accelerated phase or blast crisis if they have not received imatinib previously.
1.3. There is currently no evidence on clinical and cost effectiveness on which to base guidance on the continued use of imatinib that has been initiated in the chronic phase of CML but has failed to stop disease progression to either the accelerated phase or blast crisis. Therefore, under these circumstances the use of imatinib is recommended only in the context of further clinical study. The data for this study should be collected systematically to allow aggregation and analysis at a national level in order to inform the appraisal review.
1.4. For people in chronic-phase CML who are currently receiving interferon alpha (IFN-α) as first-line treatment, the decision about whether to change to imatinib should be informed by the response of the disease to current treatment and by the tolerance of the person to IFN-α. This decision should be made after informed discussion between the person with CML and the clinician responsible for treatment, taking full account of the evidence on the risks and benefits of imatinib and the wishes of the person.
