Chronic Myeloid Leukemia Coverage from Every Angle

SOHO 2020: TKI Discontinuation and Adherence to Practice Guidelines in Chronic-Phase CML

By: Joseph Fanelli
Posted: Thursday, October 8, 2020

According to findings presented during the 2020 Society of Hematologic Oncology (SOHO) Annual Meeting (CML-085), there remains heterogeneity in the U.S. practice of discontinuing tyrosine kinase inhibitor (TKI) therapy in patients with chronic-phase chronic myeloid leukemia (CML)—despite updates from the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology (NCCN Guidelines®)—with discontinuations occurring mostly during first-line treatment. Vamsi Kota, MD, of the Georgia Cancer Center at Augusta University, and colleagues also found that stopping TKI therapy is being practiced without adequate sensitive tools mandated by the practice.

“These findings highlight the need for a nationally implemented framework per practice guidelines so that all criteria can be met for U.S. physicians to support safe and adequate TKI therapy discontinuation, a practice that has become more commonly attempted nationally since these updates, including in community-based practices,” the authors concluded.

In this retrospective chart review, the authors collected patient data from 153 patients with Philadelphia chromosome–positive chronic-phase CML who had also received TKI therapy and had discontinued the treatment outside of an interventional clinical trial. Patient data came from hematologists and oncologists in all U.S. census regions who had experience managing patients with CML from various practice settings.

The authors found that just 44% of participating physicians had access to molecular response monitoring by a quantitative polymerase chain reaction with sensitivity to detect a molecular response of at least 4.5. In addition, almost all patients (96%) discontinued TKI therapy after achieving an adequate response in the first-line setting. Of the patients who discontinued TKI therapy, 64 patients did so in accordance with NCCN Guidelines (42%), and 36 followed European Leukemia Net guidelines (24%). Also, 32 patients relapsed after discontinuing therapy.

Disclosure: No disclosure information for study authors was provided.

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