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Do persons with chronic myeloid leukaemia have normal or near normal survival?
Recent clinical trial and population-based registry reports claimed survival of persons with chronic phase chronic myeloid leukaemia (CML) receiving tyrosine kinase-inhibitor (TKI) therapy, especially those achieving a complete cytogenetic response (CCyR; no detectable Ph1-chromosome) and/or a sustained deep molecular responses (DMR; >4 or 4.5 log reduction in BCRABL1 transcripts), is similar to that of age- and sex-matched controls [1,2,3,4]. Is this so? Although there is a high response rate to TKI-therapy, some responders relapse and a few develop blast transformation. Others become intolerant of and/or noncompliant with TKI-therapy whilst still others discontinue TKI-therapy because of fiscal considerations or adverse events ; 2nd and 3rd generation TKIs used in persons responding inadequately to 1st generation TKI-therapy associate with some adverse events which are life-threating . TKI-therapy can be successfully stopped in only about 20% of persons with CML (reviewed in [7, 8]). Lastly, it is rather unlikely TKI-therapy eliminates CML stem cells in anyone.