NICE has published guidance (Technology Appraisal 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 costing statement notes that standard-dose imatinib is the current standard of care for first-line treatment of CML (as recommended in TA 70).  Although the use of high-dose imatinib following resistance is recommended only in the context of research, specialists suggest that this, in addition to dasatinib and nilotinib, are used widely in the UK.

This guidance recommends nilotinib for adults with CML who are intolerant of or resistant to standard-dose imatinib; dasatinib and high-dose imatinib are not recommended.  The costing statement notes that the guidance is not expected to have a significant impact on resources at a national level, as the number of people involved is small and the treatment cost of currently used options as recommended in TA 70 is not significantly different to that of nilotinib (which the manufacturer is to make available with a discount).  Organisations are however asked to review their prescribing and estimate costs locally.