I thought I would post this article (I'm sure it has been posted previously but I have not seen it). It is very interesting in that, if I understood it right, most all TKI's have similar outcomes in the long term and CCyR is highly predictive of OS (similar to MMR).
"Furthermore, CCyR at 6, 12 and 18 months also significantly predicted for longer EFS, independently of the TKI modality. Furthermore, achievement of CCyR at 12 months was significantly predictive for FFS, TFS and OS irrespective of TKI modality."
"We also compared EFS according to the type of response achieved at 12 months i.e MMR alone vs CCyR with no MMR vs no MMR, no CCyR. As expected, patients who achieved 12 months MMR or CCyR without MMR had better EFS as compared with patients who did not achieve MMR or CCyR (P<0.0001) (Supplemental Figure 4)."
""The kinetics of the response to imatinib 800 and 2nd generation TKI show that there is a higher rate of the deepest responses (e.g., MR4.5). Although the rates of MMR reach similar levels by 60 months of therapy, the rates of MR4.5 remain higher with imatinib 800 and 2nd generation TKI than with imatinib 400."
The one above caught my attention in that Imatinib 400mg reaches MMR similar to the others at 60 months. Of course 60 months is way past 12 months so I think reading between the lines will help us to not worry as much, or as often as we do about MMR NOW!
"These deeper responses do not seem to offer a benefit in the risk of transformation or death, but are important if one is to consider treatment discontinuation which is currently only considered for patients with sustained undetectable transcripts."
The one above pretty much states my feeling exactly. Deep response is awesome but mostly only significant if TFR is the ultimate goal (Not overall survival). Of course I would love TFR, but OS is much more valuable to me with three kids at home.
Just thought I would post for those in CCyR who are worried about not reaching MMR quickly. Keep getting your labs every three months and monitoring that you stay under 1.0 and are either going down or on a plateau and I think things look promising.