ELN Guidelines 2020

ELN Guidelines 2020 recognise the importance of identifying and considering patient comorbidities when choosing a TKI 1

The guidelines highlight the importance of patient co-morbidities in TKI selection: 

“All TKIs have toxicities which may cause clinically relevant complications. These must be considered when selecting a TKI for a patient with comorbidities, because some are contraindications for using a specific TKI first-line. Previous or concomitant arteriovascular disease represents a strong contraindication to nilotinib first-line and ponatinib second or third line, unless there is unique need. Respiratory failure and previous or concomitant pleuro-pulmonary disease are strong contraindications to dasatinib first line. Imatinib should be withheld in patients with significant renal impairment. No other strong contraindications to imatinib or to bosutinib have been identified.1 

The table below is adapted from the updated ELN guidelines for CML treatment based on comorbidities1:

As you can see, BOSULIF® is recommended with no relevant restrictions for most previous concomitant disease, and some limitations for pancreatitis, liver disease and diarrhoea/inflammatory bowel disease.1



  1. Hochhaus A, et al Leukemia. 2020; 34(4):966-884.

Legal Category: S1A
Date of Preparation May 2021