Discontinuing TKI Therapy in CML: Focus on Treatment-Free Remission
Posted: Monday, October 5, 2020
According to a recent study published in Cancers, patients with chronic myeloid leukemia (CML) who achieved a deep molecular response may reach treatment-free remission from the discontinuation of tyrosine kinase inhibitor (TKI) therapy. François-Xavier Mahon, MD, PhD, of the Institut Bergonié, Bordeaux, France, and colleagues suggested that the duration of treatment and the use of first-line second- and third-generation TKIs may be associated with a lower risk of molecular relapse following treatment discontinuation.
Over a period of 10 years, the research team identified 398 patients with chronic-phase CML who were treated with first-line TKI therapy. The patient pool included those treated with front-line imatinib (73%; n = 291) or second- or third-generation TKIs, including nilotinib, dasatinib, and bosutinib (27%; n = 107).
After a median follow-up of 7 years, almost half of the patient pool (46%; n = 182) achieved a sustained deep molecular response of at least 24 months. The researchers found a significant positive association between gender, BCR-ABL1 transcript type, and Sokal and the Europena Treatment Outcome Study (EUTOS) Long-Term Survival risk scores and sustained deep molecular response. The use of first-line TKI therapy did not appear to be significantly associated with a sustained deep molecular response.
At a 47% probability of maintaining molecular response without resuming TKI treatment for 48 months, 95 patients joined a treatment-free remission program and discontinued treatment. The molecular recurrence–free survival rates at 12 and 48 months were 55.1% and 46.9%, respectively. Given the results, the researchers estimated that 28% of patients with CML would be optimal candidates for discontinuing TKI therapy. The duration of TKI therapy and the choice between second- and third-generation and front-line imatinib were the most significant factors associated with molecular recurrence–free survival rates.
Disclosure: The study authors reported no conflicts of interest.