Home Blood / Hematology Making Treatment Decisions About Discontinuing TKIs in Chronic Myeloid Leukemia

Making Treatment Decisions About Discontinuing TKIs in Chronic Myeloid Leukemia

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In the 1990s, the introduction of the tyrosine kinase inhibitor (TKI) imatinib for BCR-ABL-positive, chronic phase chronic myeloid leukemia (cpCML) drastically changed treatment and outcomes for patients with the disease.1 Instead of needing hematopoietic stem cell transplantation, these patients can now have their cpCML managed as a chronic disease and, indeed, they now have overall survival similar to that of age-matched controls.2 For example, the longest surviving patient with CML has been taking imatinib for over 24 years.3

Over
time, many patients with cpCML achieve deep molecular responses. Furthermore,
daily TKI treatment is often accompanied by side effects, can affect family
planning for younger patients, and may be financially burdensome.4 Because of this, researchers have
started to evaluate the discontinuation of TKIs in patients who have sustained
DMRs.1

In
an editorial published in Haematologica,
Charles Schiffer, MD, the Joseph Dresner Chair for Hematologic Malignancies in
the departments of oncology and medicine at Wayne State University School of
Medicine and the Karmanos Cancer Institute in Detroit, Michigan, summarized the
eligibility criteria for and outcomes of recent clinical trials on TKI
discontinuation.1

Although
each TKI discontinuation study conducted thus far has had slightly different
eligibility criteria, Dr Schiffer created a “consensus approximation.” Patients
must have had (1) TKI treatment for at least 3 years and (2) a continuous deep
molecular response for at least 2 years (minimum of MR4 or MR4.5).1

“The
process is quite simply that you stop [the TKI treatment] and then monitor for
the possibility of recurrence with blood tests,” explained Dr Schiffer in an
interview with Hematology Advisor.

To
monitor recurrence, the health care provider must conduct quantitative
polymerase chain reaction (qPCR) capable of detecting at least MR4.5 every 4 to
6 weeks for 6 to 8 months. Then, the qPCR monitoring may be relaxed to every 2
months for 1 year and subsequently every 3 months for at least 3 years.1

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