De-Escalation of TKI Therapy Before Complete Treatment Discontinuation in Patients With CML

BACKGROUND: All studies of treatment-free remission (TFR) in patients with chronic myeloid leukaemia have discontinued tyrosine kinase inhibitor (TKI) treatment abruptly and have focussed on patients with stable MR4 (BCR-ABL to ABL ratio ≤0·01%). We aimed to examine the effects of gradual treatment withdrawal and whether TFR is feasible for patients with a less deep but stable remission.

TAKE-HOME MESSAGE: This phase II trial was designed to evaluate a de-escalation strategy for patients with chronic myeloid leukaemia (CML) who had attained deep remission with TKI therapy. Among patients achieving MR4, 67% completed the 36-month trial period without recurrence; among those achieving MR3, 33% were recurrence-free at the end of the trial. Among those who recurred, all were able to regain a major molecular response within 5 months. Initial de-escalation before discontinuation may improve success in treatment-free remission protocols.

Prof Richard E Clark MD, Fotios Polydoros MSc, Prof Jane F Apperley MD, Dragana Milojkovic PhD, Katherine Rothwell PhD, Christopher Pocock PhD, et al.

Published June 11, 2019: https://www.thelancet.com/journals/lanhae/article/PIIS2352-3026(19)30094-8/fulltext#%20