Can any patients with chronic myeloid leukemia outside of a clinical trial have their tyrosine kinase inhibitor discontinued?

Abstract

Purpose of review 

This article critically appraises the state of treatment-free remission as a strategy for patients with chronic myeloid leukemia (CML) in deep remission after therapy with tyrosine kinase inhibitors (TKIs).

Recent findings 

Approximately half of patients with CML defined fairly narrowly by trial criteria – TKI sensitive, in deep molecular remission for a defined period – can successfully maintain protective levels of response after TKI cessation. Those who cannot appear at very low risk of disease control loss and can promptly regain remission with TKI resumption. Increasing numbers of patients followed longer term in trials have proven as well as a lack of additional late relapse in either group and that ‘functional cure’ of CML is feasible. Both the definition of remission sufficient to attempt treatment-free remission and the trigger to resume treatment have been relaxed somewhat while outcomes have remained the same. Based on repeated confirmatory data, economic pressures, and pragmatism, the question of feasibility and safety of TKI cessation outside of clinical trials is at hand.

Summary 

TKI cessation outside of clinical trials, if performed under strict guidelines, utilizing optimal monitoring techniques, with counsel available from experts in the field, and after full disclosure of the risks and benefits with the patient, may be safe (see video, supplemental digital content 1, which summarizes the abstract and offers the author's perspective,https://links.lww.com/COH/A15).