CML Interactive Cases: An Immersive Simulated Learning Experience

According to the American Cancer Society, chronic myeloid leukemia (CML) accounts for 15 to 20 percent of leukemias in adults. Management options for patients with CML include disease control using tyrosine kinase inhibitors, potential cure with allogeneic hematopoietic cell transplantation (HCT), and palliative therapy with cytotoxic agents. Among the factors that may inform treatment choice are phase of CML, patient age, presence of comorbidities, donor availability for HCT, and response to treatment with tyrosine kinase inhibitors.

This educational activity provides an opportunity to explore two different CML cases. Learners will navigate treatment decisions based on patient presentation, history, and other findings that may impact the therapeutic approach.

ASH thanks Pfizer for their support of this program.

I’m Ready to Start a Family and You’re Telling Me I Have Leukemia?!

A woman of childbearing age sees her OB/GYN for routine care and a desire to become pregnant. Routine blood work reveals findings of possible leukemia, and follow-up testing confirms CML. This case explores risk assessment and initial treatment approach, monitoring treatment response, managing side effects, long-term therapy, and the potential for treatment-free remission.

Navigating Loss of Response to First-Line Treatment for CML

A 65-year-old man with coronary artery disease and type 2 diabetes was diagnosed with CML three years ago and started treatment with first-line therapy following his CML diagnosis. The patient now experiences loss of response. This case explores possible reasons for treatment failure, monitoring and optimizing treatment adherence, monitoring treatment response and side effects, and multiple lines of therapy based on treatment history and risk.

Learning Objectives

  • Apply relevant information on new treatment developments appropriately to regimen/clinical trial selection
  • Use timely and complete risk stratification and safety/tolerability risk assessment findings to inform treatment selection
  • Explain defined milestones and related monitoring parameters that can inform optimal treatment choice
  • Identify strategies for mitigating BCR-ABL TKI treatment nonadherence

Target Audience

Hematologists, oncologists, and other health care professionals involved in the care and treatment of patients with CML.

Faculty Disclosures

Jessica Altman, MD
Northwestern University, Chicago, IL
Consultancy: Syros; Celgene; Astellas; Immune Pharmaceuticals; Janssen Pharmaceuticals; Novartis
Other: ASH, Educational Speaker; NCCN, Educational Speaker; Hemedicus, Advisor to CME Company

Elizabeth Hexner, MD, MS
University of Pennsylvania, Philadelphia, PA
Consultancy: Novartis
Research Funding: Novartis
Membership on a Board or Advisory Committee: Novartis

Jorge Cortes, MD
MD Anderson Cancer Center, Houston, TX
Consultancy: Ariad; Astellas; Biopath Holdings; BMS; Imunogen; Jazz; Novartis; Pfizer
Research Funding: Ariad; Ambit Biosciences; Astellas;Bristol-Myers Squibb; BMS; ChemGenex;Immunogen; Jazz; Novartis; Pfizer; Targegen; Teva; Wyeth
Membership on a Board or Advisory Committee: ChemGenex

Kendra Sweet, MD
Moffitt Cancer Center, Tampa, FL
Consultancy: Amgen; Astra Zeneca; Celgene; Gilead; Hospira; Pharmacyclics; Roche/Genentech; Sandoz; Takeda;
Research Funding: Karyopharm; The Leukemia and Lymphoma Society
Honoraria: Karyopharm
Speakers Bureau: Ariad; Celgene; Novartis Membership on a Board or Advisory Committee: Ariad; Novartis; Otsuka; Pfizer

Peer Reviewers

Ehab Atallah, MD
Medical College of Wisconsin, Milwaukee, WI

Jason Gotlib, MD, MS
Stanford University, Stanford, CA

Date of release

May 21, 2018

Date of expiration

Online access expiration and last date for learners to claim CME/MOC credit for this activity: May 21, 2019

Accreditation and Credit Designation

The American Society of Hematology (ASH) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education (CME) for physicians.

ASH designates this internet enduring material for a maximum of 5.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Physicians who participate in this CME activity but are not licensed in the United States are also eligible for AMA PRA Category 1 Credit™.

ABIM Maintenance of Certification Points

Successful completion of this CME activity enables the participant to earn up to 5.0 Maintenance of Certification (MOC) points in the ABIM MOC program. Participants earn MOC points equivalent to the amount of CME credits claimed for the activity.

It is the CME activity provider’s responsibility to submit participant completion information to the Accreditation Council for Continuing Medical Education (ACCME) for the purpose of granting ABIM MOC credit.

Claiming CME and ABIM Credit

The estimated time to complete this educational activity, comprised of two interactive cases, is 5.0 hours. To claim CME credit, learners must complete the post-test(s) of medical knowledge and an activity evaluation for each interactive case completed. Evaluation modules can be accessed upon completion of corresponding cases.

Learners who pass the post-tests are eligible to claim credit for the activity. The learner is allowed multiple attempts to pass the post-test for each interactive case. Successful completion of each test earns the learner a portion of the total 5.0 credit hours. Learners claim CME and/or MOC credit for each test individually.

CML Interactive Cases: An Immersive Simulated Learning Experience

Credit Hours

Case 1: I’m Ready to Start a Family and You’re Telling Me I Have Leukemia?! 2.5
Case 2: Navigating Loss of Response to First-Line Treatment for CML 2.5

On May 21, 2019, online access expires. This is also the last date for users to claim credit for this activity.

For questions about credit, please contact the ASH Education Department at or call toll-free 866-828-1231 (within the United States only).

The following resources have been identified as relevant to health care professionals involved in the care and treatment of patients with CML.

Monitoring Response in CML

In this video, Dr. Kendra Sweet provides an overview of monitoring response in patients with CML, including the significance of hematologic, cytogenetic, and molecular responses.

Perspectives on Treatment-Free Remission

In this video, Dr. Elizabeth Hexner provides a brief review of treatment-free remission in patients with CML, including historical context, when this may be considered, which patients are candidates, and what happens if a molecular response is lost.

Selected Literature and Guidelines

Baccarani M, et al. European LeukemiaNet recommendations for the management of chronic myeloid leukemia: 2013. Blood. 2013;122:872-884. Available at:

Barber MC, et al. Cardiovascular care of patients with chronic myeloid leukemia (CML) on tyrosine kinase inhibitor (TKI) therapy. Hematology Am Soc Hematol Educ Program. 2017;2017(1):110-114. Available at:

Branford S. Monitoring and defining early response: where to draw the line? Best Pract Res Clin Haematol. 2016;29(3):284-294. Available at:

Egan D, Radich J. Making the diagnosis, the tools, and risk stratification: more than just BCR-ABL. Best Pract Res Clin Haematol. 2016;29(3):252-263. Available at:

Hochhaus A, et al. Chronic myeloid leukaemia: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017;28(s4):iv41-iv51. Available at:

Jabbour E, Kantarjian H. Chronic myeloid leukemia: 2018 update on diagnosis, therapy and monitoring. Am J Hematol. 2018;93:442-459. Available at:

Mahon FX. Treatment-free remission in CML: who, how, and why? Hematology Am Soc Hematol Educ Program. 2017;2017(1):102-109. Available at:

NCCN Chronic Myeloid Leukemia: January 24, 2018;version 4. Available at:

NCCN Guidelines for Patients: 2018. Available at:

Prognostic Scoring Systems for Newly-Diagnosed CML