It is judged safe to discontinue treatment with tyrosine kinase inhibitors for chronic myeloid leukemia in experimental trials on treatment free remission. We collected a total of 293 Italian patients with chronic phase chronic myeloid leukemia who discontinued tyrosine kinase inhibitors in deep molecular response. 72% of patients were on treatment with imatinib, 28% with second generation tyrosine kinase inhibitors at the time of discontinuation. Median duration of treatment with the last tyrosine kinase inhibitor was 77 months (IQR 54;111), median duration of deep molecular response was 46 months (IQR 31;74). Duration of treatment with tyrosine kinase inhibitors and duration of deep molecular response were shorter with 2nd generation tyrosine kinase inhibitors than with imatinib (p<0.001). 88% of the Italian patients discontinued per clinical practice and reasons for stopping treatment were: toxicity for 20% of patients, pregnancy for 6% patients and shared decision between treating physician and patient for 62% of cases. After a median follow-up of 34 months (Min-Max 12-161) overall estimated treatment free remission was 62% (95% CI 56;68). At 12 months treatment free remission was 68% (95% CI 62;74) for imatinib, 73% (95% CI 64;83) for 2nd generation tyrosine kinase inhibitors. Overall median time to restart treatment was 6 months (IQR 4;11). No progressions occurred. Although our study has the limitation of a retrospective study, our experience within the Italian population confirms that discontinuation of imatinib and 2nd generation tyrosine kinase inhibitors is feasible and safe in the clinical practice
Fava, C., Rege-Cambrin, G., Dogliotti, I., Cerrano, M., Berchialla, P., Dragani, M., Rosti, G., Castagnetti, F., Gugliotta, G., Martino, B., Gambacorti-Passerini, C., Abruzzese, E., Elena, C., Pregno, P., Gozzini, A., Capodanno, I., Bergamaschi, M., Crugnola, M., Bocchia, M., Galimberti, S., Rapezzi, D., Iurlo, A., Cattaneo, D., Latagliata, R., Breccia, M., Cedrone, M., Santoro, M., Annunziata, M., Levato, L., Stagno, F., Cavazzini, F., Sgherza, N., Giai, V., Luciano, L., Russo, S., Musto, P., Caocci, G., Sora', F., Iuliano, F., Lunghi, F., Specchia, G., Pane, F., Ferrero, D., Baccarani, M., Saglio, G., Observational study of chronic myeloid leukemia Italian patients who discontinued tyrosine kinase inhibitors in clinical practice., <<HAEMATOLOGICA>>, 2019; 104 (8): 1589-1596. [doi:10.3324/haematol.2018.205054] [http://hdl.handle.net/10807/135727]
Observational study of chronic myeloid leukemia Italian patients who discontinued tyrosine kinase inhibitors in clinical practice.
Sora', Federica;
2019
Abstract
It is judged safe to discontinue treatment with tyrosine kinase inhibitors for chronic myeloid leukemia in experimental trials on treatment free remission. We collected a total of 293 Italian patients with chronic phase chronic myeloid leukemia who discontinued tyrosine kinase inhibitors in deep molecular response. 72% of patients were on treatment with imatinib, 28% with second generation tyrosine kinase inhibitors at the time of discontinuation. Median duration of treatment with the last tyrosine kinase inhibitor was 77 months (IQR 54;111), median duration of deep molecular response was 46 months (IQR 31;74). Duration of treatment with tyrosine kinase inhibitors and duration of deep molecular response were shorter with 2nd generation tyrosine kinase inhibitors than with imatinib (p<0.001). 88% of the Italian patients discontinued per clinical practice and reasons for stopping treatment were: toxicity for 20% of patients, pregnancy for 6% patients and shared decision between treating physician and patient for 62% of cases. After a median follow-up of 34 months (Min-Max 12-161) overall estimated treatment free remission was 62% (95% CI 56;68). At 12 months treatment free remission was 68% (95% CI 62;74) for imatinib, 73% (95% CI 64;83) for 2nd generation tyrosine kinase inhibitors. Overall median time to restart treatment was 6 months (IQR 4;11). No progressions occurred. Although our study has the limitation of a retrospective study, our experience within the Italian population confirms that discontinuation of imatinib and 2nd generation tyrosine kinase inhibitors is feasible and safe in the clinical practiceFile | Dimensione | Formato | |
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