Safety and efficacy of imatinib cessation for CML patients with stable undetectable MRD: results from the TWISTER Study

Ross1,*, Susan Branford2, John F. Seymour3, Anthony P. Schwarer4, Christopher Arthur5, David T. Yeung6, Phuong Dang1, Jarrad M. Goyne1, Cassandra Slader7, Robin J. Filshie8, Anthony K. Mills9, Junia V. Melo10, Deborah L. White1, Andrew P. Grigg11, and Timothy P. Hughes1

Key points

* Around 40% of patients with undetectable minimal residual disease on imatinib can stop treatment without loss of molecular response.

* Patients in treatment-free remission (TFR) still have detectable BCR-ABL DNA several years after stopping imatinib.

Abstract
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http://bloodjournal.hematologylibrary.org/content/early/2013/05/23/blood...

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TWIST it but don’t spin it
Jane F. Apperley

'.........This is the first prospective study to confirm the observations of the Stop Imatinib (STIM) study, in which 40% of patients who had achieved deep molecular responses (MRs) on imatinib could discontinue the drug without experiencing relapse,2 which led to speculation that “cure” could be achieved by using oral tyrosine kinase inhibitors (TKIs) alone. Subsequently, randomized phase 3 studies comparing the more potent second generation TKI (2GTKI) with imatinib as first-line therapy showed that these very deep responses were obtained more rapidly and probably in a higher proportion of patients than with imatinib3,4 and resulted in the dilemma currently besetting chronic myeloid leukemia patients and their physicians, namely the choice of the first-line agent.....'

full article....
http://bloodjournal.hematologylibrary.org/content/122/4/470.full