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Journal Article Epublish 4 citations

PubMed: 36755944 DOI: 10.3389/fphar.2023.1101743

Successful treatment discontinuation in CML patients with full-dose and low-dose TKI: Results from real-world practice.

Front Pharmacol 14:1101743

Authors: Yilin Chen, Huifang Zhao, Jingming Guo, Jing Zou, Wenjuan He, Danlei Han, Fanjun Cheng, Yanli Zhang, Weiming Li

Affiliations

  • Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
  • Department of Hematology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China.
  • Department of Hematology, Yichang Central People's Hospital & First Clinical Medical College of China Three Gorges University, Yichang, Hubei, China.

Abstract

In clinical studies, some patients who achieve deep molecular response (DMR) can successfully discontinue tyrosine kinase inhibitor (TKI). TKI dose reduction is also an important aspect of alleviating adverse effects and improving quality of life. This study aimed to explore the outcome after drug withdrawal in Chinese CML patients. We conducted a retrospective analysis of the outcome of 190 patients who stopped TKI. 27 patients experienced dose reduction before TKI discontinuation. The median duration of TKI treatment and MR4 before discontinuation was 82 months and 61 months. With median follow-up after stopping TKI treatment of 17 months, the estimated TFR (Treatment Free Remission) were 76.9% (95%CI, 70.2%-82.4%), 68.8% (95%CI, 61.3%-75.2%), and 65.5% (95%CI, 57.4%-72.5%) at 6, 12 and 24 months. For full-dose and low-dose TKI groups, the TFR at 24 months was 66.7% and 55.8% ( = 0.320, log-rank). Most patients (56/57) quickly achieved MMR after restarting TKI treatment. Multivariable analysis showed that patients with TKI resistance had a higher risk of molecular relapse than patients without TKI resistance ( < 0.001). TFR rates were not impaired in patients experiencing dose reduction before TKI discontinuation compared to patients with full-dose TKI. Our data on Chinese population may provide a basis for the safety and feasibility of TKI discontinuation, including discontinuation after dose reduction, in clinical practice.

MeSH

Leukemia, Myelogenous, Chronic, Bcr-Abl Positive, Therapeutics

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