Feasibility of treatment discontinuation in chronic myeloid leukemia in clinical practice: results from a nationwide series of 236 patients View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2018-10

AUTHORS

Juan Carlos Hernández-Boluda, Arturo Pereira, Irene Pastor-Galán, Alberto Alvarez-Larrán, Alisa Savchuk, José Manuel Puerta, José María Sánchez-Pina, Rosa Collado, Alvaro Díaz-González, Anna Angona, Miguel Sagüés, Valentín García-Gutiérrez, Concepción Boqué, Santiago Osorio, Rolando Vallansot, Luis Palomera, Arantxa Mendizábal, Luis Felipe Casado, Manuel Pérez-Encinas, Raúl Pérez-López, Francisca Ferrer-Marín, Fermín Sánchez-Guijo, Carmen García, Natalia de las Heras, José Luis López-Lorenzo, Francisco Cervantes, Juan Luis Steegmann,

ABSTRACT

Over half of chronic myeloid leukemia (CML) patients in deep molecular response do not lose the major molecular response (MMR) after stopping treatment with tyrosine kinase inhibitors (TKI). This strategy is safe in clinical trials, but its applicability in the real-life setting remains unsettled. We describe the outcomes after TKI discontinuation in a nationwide series of 236 CML patients. Median follow-up from treatment discontinuation was 21.5 months and 5 patients died from CML-unrelated causes. TKI therapy was reinitiated due to MMR loss (n = 52), increase ≥ 1 log in BCR-ABL transcript level without losing MMR (n = 12), patient preference (n = 2), and withdrawal syndrome (n = 1). Treatment-free remission rate at 4 years was 64% (95% confidence interval, CI: 55%-72%). Cumulative incidence of molecular recurrence at 3 years was 33% (95% CI: 26%-38%). TKI treatment for < 5 years and MR4.5 duration shorter than 4 years were both associated with higher incidence of molecular recurrence. No patient had disease progression. Response status at last control was: MR4.5 (n = 196), MR4 (n = 15), MMR (n = 14), complete cytogenetic response (n = 10), and other (n = 1). A significant increase in Hb and cholesterol levels was observed after imatinib withdrawal. Our results demonstrate that TKI treatment discontinuation is feasible in real-life clinical practice. More... »

PAGES

91

Identifiers

URI

http://scigraph.springernature.com/pub.10.1038/s41408-018-0125-0

DOI

http://dx.doi.org/10.1038/s41408-018-0125-0

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1107194753

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/30504932


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