In a nutshell
The review aimed to develop recommendations for stopping tyrosine kinase inhibitor (TKI) therapy in patients with chronic myeloid leukemia CML.
Some background
Tyrosine kinase inhibitors (TKI) are a type of targeted therapy. TKIs have improved the survival outcomes for patients with chronic myeloid leukemia (CML). Treatment-free remission (TFR) is achieved when a patient who ends TKI therapy maintains a major molecular response (MMR) and does not need to restart therapy. A MMR is when the BCR-ABL gene (found on CML cells) in the blood or bone marrow is very low (less than 0.001%). TFR is a new goal of CML treatment.
Recommendations for patients stopping TKI therapy in real-life settings are required.
Methods & findings
This review involved a group of CML experts who discussed 22 questions regarding TFR in CML patients. Recommendations for TFR for CML patients were established.
TFR is suggested in CML patients in the first chronic phase (CP), who have been treated with TKIs for a minimum of 5 years and have a deep molecular response (DMR) for 2 years. A DMR is when the BCR-ABL gene in the blood or bone marrow is 0.01% or lower. Sustained DMR must be demonstrated in the immediate prior 2 years.
After second-line treatment, TFR is suggested in previously intolerant patients, not resistant. Molecular monitoring is recommended at regular intervals (every month in the first 6 months, every 2-3 months up to a year, and every 3 months thereafter), indefinitely. Treatment should be restarted if there is a loss of MMR (if BCR-ABL is higher than 0.1%).
After restarting therapy, patients should be monitored for MMR every 2-3 months. If the patient does not achieve MMR after 3-6 months, mutation screening should be performed.
After stopping TKI, some patients can experience withdrawal syndrome (WS). WS involves muscle and skeletal pain. Patients should be warned about this risk and should be monitored. Monitoring of glucose levels and lipid (blood fats) profile are recommended after stopping TKI.
The bottom line
This review provided recommendations for stopping TKI treatment in patients with CML.
Published By :
Blood advances
Date :
Aug 26, 2021
