skip to main content

CML — SCE Medical Oncology MCQ

Instant feedback + full explanation. One question, done properly.

HardImmunotherapy & Targeted TherapyCMLSCE Medical Oncology

A patient with chronic-phase CML loses molecular response after sequential imatinib and dasatinib. BCR::ABL1 kinase-domain sequencing identifies T315I, and cardiovascular risk has been assessed. Which targeted treatment has a NICE recommendation specifically covering this mutation?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Ponatinib because the T315I mutation is an explicit TA451 indication

TA451 recommends ponatinib for CML in chronic, accelerated or blast phase when T315I is present, as well as in specified resistant or intolerant settings. T315I confers resistance to imatinib and the conventional second-generation TKIs, so recycling imatinib, nilotinib or bosutinib is not mutation-directed. Cardiovascular risk and dose strategy still require specialist assessment, but chronic phase does not remove the NICE indication.

Reference: NICE TA451 ponatinib for chronic myeloid leukaemia and acute lymphoblastic leukaemia (Published June 2017): https://www.nice.org.uk/guidance/ta451/chapter/1-Recommendations