Dr. Naval Daver on Optimizing Therapy in CML and MPNs

Naval G. Daver, MD, professor and director, Leukemia Research Alliance Program, Department of Leukemia, the University of Texas MD Anderson Cancer Center, gives insights about the chronic myeloid leukemia (CML) and myeloproliferative neoplasms (MPNs) session held during the 2nd Annual HemOnc Pulse Live! in Austin, TX. There have been major advancements and ongoing challenges in the field, says Dr. Daver, and they were explored in depth during the session. The speakers highlighted the transformative impact of tyrosine kinase inhibitors (TKIs) on the prognosis of CML—shifting five-year survival rates from below 10% in the 1980s to an astounding 96% today. With six TKIs now approved for CML, the focus has turned toward optimizing therapy, particularly identifying which patients may safely discontinue treatment and potentially achieve a true cure.

The session also explores current research on biomarkers and treatment kinetics that can predict safe discontinuation timelines, as well as the increasing adoption of treatment-free remission strategies in both academic and community practice.

Transitioning to MPNs, the discussion covers the state of JAK inhibitor therapy in primary and secondary myelofibrosis. While four JAK inhibitors—ruxolitinib, fedratinib, pacritinib, and momelotinib—are approved and effective for symptom control and disease management, they do not provide deep molecular remissions or curative outcomes. This reality underscores the need for new combination approaches.

Emerging research is focused on pairing JAK inhibitors with agents such as hypomethylating drugs, BET inhibitors, and BCL-2/BCL-XL-targeted therapies. Several phase 3 trials are currently underway, aiming to produce more durable and complete remissions and reduce the need for lifelong therapy.

Altogether, this session captures the momentum in CML and MPN research—shifting from disease control to potential treatment discontinuation and, ultimately, cure.