Optimal timeframes & summary

Evidence-based guidelines, where they exist, should inform timeframes. Treatment teams need to recognise that shorter timeframes for appropriate consultations and treatment can promote a better experience for patients. Three steps in the pathway specify timeframes for care (Figure 3). They

are designed to help patients understand the timeframes in which they can expect to be assessed and treated, and to help health services plan care delivery in accordance with expert-informed time parameters to meet the expectation of patients. These timeframes are based on expert advice from the Chronic Myeloid Leukaemia Working Group.

Timeframes for care of chronic myeloid leukaemia

Step in pathway Care point Timeframe
Presentation, initial investigations and referral Signs and symptoms Presenting signs and symptoms should be promptly assessed.
Initial investigations initiated by GP When CML is suspected, a full blood count should be conducted and checked within 3 days, or more rapidly if there is any indication for urgency.
Referral to specialist A specialist review should be conducted within 2 weeks of the GP’s assessment, or immediately in specific cases. Some cases may require immediate hospitalisation.
Diagnosis, staging and treatment planning Diagnosis and staging Specialist assessments should generally be completed within 2 weeks.
Multidisciplinary team meeting and treatment planning After completing assessment, a treatment plan should be discussed with the patient and a joint plan made within 2 weeks.
Treatment Initial cytoreductive therapy If indicated, hydroxyurea and/or anagrelide should be started as soon as leucocytosis and/or thrombocytosis has been identified.
TKI therapy Ideally TKI therapy should begin within 4 weeks, unless there is a specific indication to delay.
Blast phase CML Initiating therapy is urgent in blast phase CML. Ideally chemotherapy and/or TKI therapy should be started within 1 week of diagnosis.

Seven steps of the optimal care pathway

Step 1: Prevention and early detection

Step 2: Presentation, initial investigations and referral step

Step 3: Diagnosis, staging and treatment planning

Step 4: Treatment

Step 5: Care after initial treatment and recovery

Step 6: Managing refractory, relapsed, residual or progressive disease

Step 7: End-of-life care

CML is a disease of haematopoietic stem cells. It is defined by the presence of the Philadelphia chromosome, which results from a reciprocal translocation between chromosome 9 and 22, that gives rise to a BCR-ABL1 fusion gene.

According to Australian Institute of Health Welfare (2021), the median age of diagnosis in Australia was estimated to be 63; however, other sources report that the median age of diagnosis in western countries is around 57 (Hochhaus et al. 2020).

The prevalence of CML has steadily increased as targeted therapies have improved survival to rates that are similar to the general population (Bower et al. 2016; Brunner et al. 2013; Hocchaus et al. 2020).

CML is rarely diagnosed in children, and treatment strategies for paediatric CML differ from what is recommended for adults. This pathway does not discuss treatment for children with CML.

ia in Australia, accounting for nearly half of all leukaemia diagnoses. In 2021, the yearly incidence rate of cml in Australian adults was estimated to be 7.0 cases per 100,000, with a five-year relative survival rate of 84.9 per cent. The median age of diagnosis in Australia was estimated to be 71 years of age,

with 83 per cent of all patients diagnosed being 60 or older. cml is more common in males, with 9.4 cases per 100,000 compared with 5.0 cases per 100,000 in females (AIHW 2021).