Discontinuing Tyrosine Kinase Inhibitor Therapy in Chronic Myelogenous Leukemia: Current Understanding and Future Directions

Publication date: Available online 16 June 2016 Source:Clinical Lymphoma Myeloma and Leukemia Author(s): S. Bhalla, D. Tremblay, J. Mascarenhas BCR-ABL1 tyrosine kinase inhibitors (TKIs) have dramatically transformed the treatment of patients with chronic myelogenous leukemia (CML). Given the impressive and sustained response to TKI therapy the majority of treated CML patients enjoy, recent studies have explored the potential to achieve treatment free remission (TFR) in select patients, which may allow these patients to escape the adverse clinical and financial effects associated with life-long TKI therapy. The results of multiple prospective trials have demonstrated that patients who maintain a deep molecular response for at least two years with TKI treatment may be eligible for trial of TKI discontinuation. Mounting data indicates that approximately 40% of those who discontinue therapy on trial will remain in remission at least one year after TKI discontinuation, the majority of patients with molecular recurrence relapse within the first six months after TKI discontinuation, and TKI retreatment is highly effective in restoring response. Sokol score, duration of TKI therapy, depth of molecular response, and the presence of natural killer cells may all be associated with a higher probability of attaining TFR. Moving forward, emerging data from ongoing TKI discontinuation trials will allow for appropriate selection of CML patients eligible for this approach, will exp...
Source: Clinical Lymphoma Myeloma and Leukemia - Category: Cancer & Oncology Source Type: research