Chronic Myeloid Leukemia Coverage from Every Angle

Late Molecular Recurrence and Treatment-Free Remission in CML

By: Joseph Fanelli
Posted: Wednesday, September 23, 2020

According to a prolonged follow-up study of treatment-free remission in patients with chronic myeloid leukemia (CML) presented in Blood Advances, 14% of all molecular recurrences occurred after 2 years of treatment-free remission. These late event molecular recurrences were observed in patients with fluctuating measurements in minimal residual disease, noted Marc Spentchian, MD, of the Centre Hospitalier de Versailles, Le Chesnay, France, and colleagues.

“Late molecular recurrences are predominantly observed in treatment-free remission patients with fluctuating minimal residual disease, justifying close long-term minimal residual disease monitoring of these patients,” the authors concluded.

The authors focused on 128 patients who participated in the 15-year Stop Imatinib (STIM) trial. Molecular recurrence was defined by the loss of major molecular response. At the first transmission-free remission attempt, patients were treated with a tyrosine kinase inhibitor for a median of 7.1 years and BCR-ABL1IS ≤ 0.01% for a median of 4 years. The median follow-up of patients in treatment-free remission was 6.5 years.

After 7 years, the transmission-free remission rate was estimated to be 45.6%. For the 9 of 65 patients who experienced molecular recurrence, it occurred after 2 years in treatment-free remission (with a median of 3.6 years). The residual rate of molecular recurrences after 2 years was estimated to be 18%.

The authors found that the probability of remaining in treatment-free remission was 65.4% for patients who experienced fluctuations in their assessment of minimal residual disease, whereas it was 100% for those with stable minimal residual disease.

Disclosure: The authors reported no conflicts of interest.

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