Indication of allo-SCT for children with CML in TKI era
| Indication . | Comment . |
|---|---|
| No consensus | Data on long-term outcomes in children remain sparse. |
| Advanced phase (CML-AP or CML-BP) at diagnosis | 2G-TKI is recommended first. If a suitable donor is not available and milestones are achieved, TKI may be continued under close monitoring. |
| Progression to CML-AP or CML-BP | Undertake attempt to achieve a second CP with 2G-TKI first. |
| Resistance to 2 TKIs; unacceptable intolerance to all TKIs licensed; T315I mutation | Give ponatinib first, if available, and only for bridging to SCT.* |
| Indication . | Comment . |
|---|---|
| No consensus | Data on long-term outcomes in children remain sparse. |
| Advanced phase (CML-AP or CML-BP) at diagnosis | 2G-TKI is recommended first. If a suitable donor is not available and milestones are achieved, TKI may be continued under close monitoring. |
| Progression to CML-AP or CML-BP | Undertake attempt to achieve a second CP with 2G-TKI first. |
| Resistance to 2 TKIs; unacceptable intolerance to all TKIs licensed; T315I mutation | Give ponatinib first, if available, and only for bridging to SCT.* |
Ponatinib is not approved for use in children. No pediatric studies have been conducted and no safe pediatric dose can be recommended.