Continuing our series of CML education events around the world, the iCMLf recently hosted three Regional Discussion Group meetings for Latin America. These webinars bring together physicians and scientists to discuss specific challenges of managing CML across Latin America. The sessions covered; the choice and order of TKIs managing chronic treatment effects, strategies for stopping CML therapy, and applying the ELN laboratory guidelines in low- and middle-income countries. The sessions were attended by over ​​130 attendees from 15 countries.

We are incredibly grateful for the time and input from all of the experts and for support from Novartis for these meetings, which allowed simultaneous translation in Spanish and Portuguese.

The discussions highlighted five key themes:

1. Access to diagnostics and monitoring

A prominent issue discussed in all meetings was the lack of consistent access to diagnostic tools, particularly molecular PCR and mutation testing. These tools are critical for early diagnosis and for monitoring the response to treatment and for disease progression. However, in many resource-limited regions, access to these tests is either delayed or unavailable. 

Physicians emphasised the importance of prioritising high-risk patients for testing and called for advocacy efforts to improve access to these life-saving tools. The discussions highlighted the need to work within existing healthcare infrastructures while pushing for improved resource allocation.

2. TKI sequencing and limited treatment options

As more TKIs become available, the issue of TKI sequencing - choosing the right drug after first-line treatment failure - is a growing concern. Physicians in Latin America often face limited access to second and third generation TKIs like dasatinib, nilotinib, and bosutinib, which complicates patient management when resistance or intolerance to first-line imatinib occurs.

The discussions underscored the need for advocacy to improve access to these medications, which are crucial for patients who develop resistance to first-line treatments like imatinib. Physicians must balance efficacy, side effects, and comorbidities when choosing treatment options, but timely access to these drugs remains a challenge.

3. Managing long-term side effects

As patients live longer on TKIs, managing chronic side effects, particularly cardiovascular and pulmonary complications, is becoming increasingly important. This challenge is compounded by limited access to alternative treatments in many areas. Pediatric CML was also discussed as a unique challenge, with special attention to the long-term effects of treatment on children’s growth and development. The takeaway for clinicians is the need for close monitoring of side effects and the adoption of a holistic approach to patient care, balancing disease management with quality of life considerations. Advocacy was highlighted as essential in ensuring access to comprehensive care, including both physical and psychological support for pediatric patients.

4. Economic barriers and advocacy for treatment discontinuation

A significant portion of the third meeting focused on the potential for cost savings through treatment-free remission (TFR) for patients who have sustained deep molecular responses. The economic data presented showed that discontinuing TKIs, when feasible, could result in substantial savings for healthcare systems. However, resistance from health providers, who are often hesitant to fund the required frequent testing during remission, remains a major hurdle. Advocacy at both local and governmental levels is crucial to overcoming this barrier. During the discussions, experts highlighted that a more unified approach, such as creating national or regional guidelines, might help governments and providers better understand the cost-effectiveness of TFR.

5. Collaboration and knowledge sharing

Throughout the series, the importance of collaboration was a recurring theme. Sharing knowledge and experiences among healthcare professionals is vital, particularly in resource-limited settings where the application of international guidelines may be challenging. During the third meeting, a robust conversation about advocacy efforts underscored how the iCMLf could help clinicians and patient advocates work together to push for better policies, improved access to diagnostics and treatments, and greater financial support for molecular monitoring. The iCMLf’s role in facilitating these efforts and providing resources for advocacy was seen as essential in addressing the region’s challenges.

You can catch up on all of the Latin American Regional Discussion Groups, including presentations in Spanish and Portuguese at our YouTube channel.