Treatment-free remission in patients with chronic myeloid leukemia: Recommendations of the LALNET expert panel

Carolina Pavlovsky, Virginia Abello Polo, Katia Pagnano, Ana Ines Varela, Claudia Agudelo, Michele Bianchini, Carla Boquimpani, Renato Centrone, Monica Conchon, Nancy Delgado, Vaneuza Funke, Isabel Giere, Ingrid Luise, Luis Meillon, Beatriz Moiraghi, Juan Ramon Navarro, Lilian Pilleux, Ana Ines Prado, Soledad Undurraga, Jorge Cortes

Research output: Contribution to journalArticlepeer-review

Abstract

Tyrosine kinase inhibitors (TKIs) have dramatically changed the survival of chronic myeloid leukemia (CML) patients, and treatment-free remission (TFR) has recently emerged as a new goal of CML treatment. The aim of this work was to develop recommendations for TKI discontinuation in Latin America (LA), outside of clinical trials. A working group of CML experts from LA discussed 22 questions regarding TFR and reached a consensus for TFR recommendations in the region. TFR is indicated in patients in first chronic phase, with typical BCR-ABL transcripts, under TKI treatment of a minimum of 5 years, in sustained deep molecular response (DMR; molecular response 4.5 [MR4.5]) for 2 years. Sustained DMR must be demonstrated on at least 4 international reporting scale quantitative polymerase chain reaction (PCR) tests, separated by at least 3 months, in the immediate prior 2 years. After second-line therapy, TFR is indicated in previously intolerant, not resistant, patients. Molecular monitoring is recommended monthly for the first 6 months, every 2 to 3 months from months 7 to 12, and every 3 months during the second year, indefinitely. Treatment should be reintroduced if major molecular response is lost. Monitoring of withdrawal syndrome, glucose levels, and lipid profile is recommended after discontinuation. After TKI reintroduction, molecular monitoring is indicated every 2 to 3 months until MR4.0 achievement; later, every 3 to 6 months. For the TFR attempt, having standardized and reliable BCR-ABL PCR tests is mandatory. These recommendations will be useful for safe discontinuation in daily practice and will benefit patients who wish to stop treatment in emergent regions, in particular, with TKI-related chronic adverse events.

Original languageEnglish (US)
Pages (from-to)4855-4863
Number of pages9
JournalBlood Advances
Volume5
Issue number23
DOIs
StatePublished - Dec 14 2021

ASJC Scopus subject areas

  • Hematology

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