Tyrosine kinase inhibitor discontinuation in chronic myeloid leukaemia patients in both clinical trials and daily clinical practice

Czech version

Authors: P. Čičátková; D. Žáčková
Authors‘ workplace: Interní hematologická a onkologická klinika, Fakultní nemocnice Brno a Lékařská fakulta Masarykovy univerzity, Brno
Published in: Transfuze Hematol. dnes,26, 2020, No. 4, p. 279-291.
Category: Review/Educational Papers

Overview

The introduction of tyrosine kinase inhibitors into clinical practice led to dramatic improvement of chronic myeloid leukaemia patient prognosis. The life expectancy of newly diagnosed chronic myeloid leukaemia patients is almost the same as that of the general population, a unique feature not only in haematology but also in oncology per se. However, in the case of many patients this is offset by the need for long-term, lifelong pharmacotherapy with all its negative consequences such as side effects, economic burden and pregnancy planning restriction. Adverse events may negatively affect patient quality of life, restrict routine daily activities and serious events associated especially with second and third generation tyrosine kinase inhibitors may even prove life-threatening. Depending on the TKI selected, 30-50% of patients achieve a deep molecular response. In individuals with stable deep molecular response, tyrosine kinase inhibitor discontinuation and subsequent treatment-free remission maintenance have become the new goal of CML treatment. Although treatment-free remission may be associated with some drawbacks such as withdrawal syndrome and a degree of late relapse risk, it definitely represents a relatively safe alternative to long-term therapy and is now proceeding from clinical trials into daily clinical practice. This article summarizes comprehensively clinical trials focused on treatment-free remission in CML patients, including their implications for daily clinical practice and potential consequences of tyrosine kinase inhibitors cessation.

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