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In this review, the authors discuss currently available therapies for CML, focusing on mechanisms of resistance to imatinib and treatment strategies to overcome resistance. Relevant articles were identified through searches of PubMed and abstracts from international hematology\/oncology congresses. Additional information sources were identified from the bibliographies of these references and from the authors' own libraries and expertise. In vitro 50% inhibitory concentration (IC<jats:sub>50<\/jats:sub>) data alone are not sufficient to guide the choice of a tyrosine kinase inhibitor (TKI) in the presence of a mutant breakpoint cluster region\u2010v\u2010abl Abelson murine leukemia viral oncogene homolog (BCR\u2010ABL) clone, because there is a lack of data regarding how well such IC<jats:sub>50<\/jats:sub> values correlate with clinical response. A small subset of BCR\u2010ABL mutant clones have been associated with impaired responses to second\u2010generation TKIs (tyrosine to histidine mutation at codon 253 [Y253H], glutamic acid to lysine or valine mutation at codon 255 [E255K\/V], and phenylalanine to cysteine or valine mutation at codon 359 [F359C\/V] for nilotinib; valine to leucine mutation at codon 299 [V299L] and F317L for dasatinib); neither nilotinib nor dasatinib is active against the threonine to isoleucine mutation at codon 315 (T315I). For each second\u2010generation TKI, the detection of 1 of a small subset of mutations at the time of resistance may be helpful in the selection of second\u2010line therapy. For the majority of patients, comorbidities and drug safety profiles should be the basis for choosing a second\u2010line agent. Clinical trial data from an evaluation of the response of specific mutant BCR\u2010ABL clones to TKIs is needed to establish the role of mutation testing in the management of CML. Cancer 2011. \u00a9 2010 American Cancer Society.<\/jats:p>","DOI":"10.1002\/cncr.25717","type":"journal-article","created":{"date-parts":[[2010,11,29]],"date-time":"2010-11-29T13:12:30Z","timestamp":1291036350000},"page":"1800-1811","source":"Crossref","is-referenced-by-count":66,"title":["Practical advice for determining the role of <i>BCR\u2010ABL<\/i> mutations in guiding tyrosine kinase inhibitor therapy in patients with chronic myeloid leukemia"],"prefix":"10.1002","volume":"117","author":[{"given":"Elias","family":"Jabbour","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Branford","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Saglio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dan","family":"Jones","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge E.","family":"Cortes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hagop M.","family":"Kantarjian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2010,11,29]]},"reference":[{"key":"e_1_2_4_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa022457"},{"key":"e_1_2_4_3_2","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2009.38"},{"key":"e_1_2_4_4_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2009.25.0779"},{"key":"e_1_2_4_5_2","volume-title":"National Comprehensive Cancer Network. 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