Background
Treatment-free remission (TFR), the ability to maintain a molecular response (MR), occurs in approximately 50% of patients with chronic myelogenous leukemia (CML) treated with tyrosine kinase inhibitors (TKIs).
Methods
A multicenter phase 2 trial (Delightedly Overcome CML Expert Stop TKI Trial: DOMEST Trial) was conducted to test the safety and efficacy of discontinuing imatinib. Patients with CML with a sustained MR of 4.0 or MR4.0-equivalent for at least 2 years and confirmed MR4.0 at the beginning of the study were enrolled. In the TFR phase, the international scale (IS) was regularly monitored by IS-PCR testing. Molecular recurrence was defined as the loss of MR4.0. Recurrent patients were immediately treated with dasatinib or other TKIs including imatinib.
Results
Of 110 enrolled patients, 99 were evaluable. The median time from diagnosis to discontinuation of imatinib was 103 months, and the median duration of imatinib therapy was 100 months. Molecular recurrence-free survival rates were 69.6%, 68.6% and 64.3% at 6, 12, and 24 months, respectively. After discontinuation of imatinib therapy, 26 patients showed molecular recurrence, and 25 re-achieved deep MR after dasatinib treatment. Molecular response MR4.0 was achieved in 23 patients within 6 months and 25 patients within 12 months. Multivariate analysis revealed that a longer time from diagnosis to discontinuation of imatinib therapy (
p
= 0.0002) and long duration of imatinib therapy (
p
= 0.0029) predicted a favorable prognosis.
Conclusions
This DOMEST Trial showed the feasibility of TKI discontinuation in a Japanese clinical setting.
Pure erythroid leukemia (PEL) is an extremely rare type of acute myeloid leukemia (AML), accounting for fewer than 1% of all AML cases. A 72-year-old man presented with severe fatigue. His bone marrow aspiration contained myeloperoxidase negative abnormal cells that were aggregating and depicting epithelial adhesion, suggesting the possibility of solid tumor metastasis. His general condition deteriorated during medical diagnosis, and he died soon after starting chemotherapy. PEL appeared to be the definitive diagnosis after evaluating the histopathological findings, which were obtained after his death. With atypical morphological features, immunophenotypic and karyotypic approaches must be integrated for PEL assessment.
A 56-year-old Japanese man was admitted to our hospital due to a fever of unknown origin. He had had a history of extranodal natural killer (NK)/T-cell lymphoma, nasal type, and had been in complete remission for 7 years until June 2003, when he developed high fever, eyelid swelling, and muscular weakness. Serum creatine kinase levels were elevated. Histopathological examination of skin and muscle biopsy specimens revealed subcutaneous infiltration of lymphoid cells positive for CD3, CD56, and Epstein-Barr virus-encoded small nuclear RNA-1. We report this unique case of Epstein-Barr virus-associated lymphoma mimicking dermatomyositis.
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