Does the frequency of molecular monitoring after tyrosine kinase inhibitor discontinuation affect outcomes of patients with chronic myeloid leukemia?

Abstract

With the limitations of a small sample size, the results of the current study demonstrate that less frequent monitoring of BCR-ABL1 does not appear to affect outcomes, and that discontinuation of TKIs used as first-line treatment or beyond after resistance or intolerance to first-line treatment appears feasible. Cancer 2017;123:2482-88. © 2017 American Cancer Society.

Observational study of chronic myeloid leukemia Italian patients who discontinued tyrosine kinase inhibitors in clinical practice

“…21 Although we may think that a stringent monitoring is protective, and indeed most of the relapses occurred during the first year, late relapses were not complicated by loss of complete hematologic remission or progression to advanced phases, even if monitoring was less frequent. 32 Given this, we must mention that Italian centers rely on the Lab-net CML network, which ensures a standardized measurement of minimal residual disease, with a short turn-around time between sampling and reporting.…”

Discontinuation of tyrosine kinase inhibitors in chronic myeloid leukemia: Recommendations for clinical practice from the French Chronic Myeloid Leukemia Study Group

“…Early relapses are characterized by an exponential increase in BCR‐ABL1 (rising by 0.5‐1 log per month), whereas later relapses usually have slower kinetics . Nevertheless, we recognize that slightly less frequent monitoring during the first year may not substantially affect outcomes . How often tests should be performed in patients who remain treatment‐free in the long term is an open question because surveillance data beyond 3 to 5 years are limited.…”

“…8,9,30 Nevertheless, we recognize that slightly less frequent monitoring during the first year may not substantially affect outcomes. 37 How often tests should be performed in patients who remain treatment-free in the long term is an open question because surveillance data beyond 3 to 5 years are limited. The frequency may be adapted to the individual patient's residual disease level and evolution pattern.…”

Long-Term Outcomes of Tyrosine Kinase Inhibitors Treatment for Chronic Myeloid Leukemia

“…After interrupting the TKI, it is necessary to frequently monitor PCR every three months (first year) and every six months afterward, until loss of response. It is possible that the frequency of the determinations is exaggerated and may be reduced [32].…”