NICE has published a technology appraisal (TA 241) on the use of dasatinib, high-dose imatinib and nilotinib for the treatment of imatinib-resistant chronic myeloid leukaemia (CML) (part review of NICE technology appraisal guidance 70), and dasatinib and nilotinib for people with CML for whom treatment with imatinib has failed because of intolerance.

The main recommendations regarding the use of these medicines within the NHS in England and Wales are as follows:

• Nilotinib is recommended for the treatment of chronic or accelerated phase Philadelphia-chromosome-positive CML in adults whose CML is resistant to treatment with standard-dose imatinib or who have imatinib intolerance, as long as the manufacturer makes nilotinib available with the discount agreed as part of the patient access scheme.

• Dasatinib is not recommended for the treatment of chronic, accelerated or blast-crisis phase CML in adults with imatinib intolerance or whose CML is resistant to treatment with standard-dose imatinib.

• High-dose imatinib (600mg or 800mg in the chronic phase disease or 800mg in the accelerated phase or blast crisis) is not recommended for the treatment of chronic, accelerated or blast-crisis phase Philadelphia-chromosome-positive CML that is resistant to standard-dose imatinib.

People who are currently receiving dasatinib or high-dose imatinib for the treatment of CML should have the option to continue treatment until they and their clinicians consider it appropriate to stop.

This is a part review of (and should be read in conjunction with) NICE technology appraisal guidance 70 (October 2003) on imatinib for CML.