Discontinuation of tyrosine kinase inhibitors in chronic myeloid leukemia: when is this a safe option to consider?

Sweet, Kendra

doi:10.1182/asheducation-2013.1.184

Cited by 12 publications

(13 citation statements)

References 35 publications

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“…Although treatment-free remission is currently only possible for highly selected patients within clinical trial confines, in the future this may become the treatment goal for patients with good-risk disease. 2 However, some patients still progress to accelerated phase or blast crisis. A strategy to promptly identify patients truly requiring additional therapy is among the top priorities for CML research.…”

Section: Discussionmentioning

confidence: 99%

Prognostic significance of early molecular response in chronic myeloid leukemia patients treated with tyrosine kinase inhibitors

Yeung

Mauro

2014

Hematology

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A 55-year-old man presented with splenomegaly (10 cm below left costal margin) and leucocytosis (145 ϫ 10 9 /L). Differential showed neutrophilia with increased basophils (2%), eosinophils (1.5%), and left shift including myeloblasts (3%). A diagnosis of chronic myeloid leukemia in chronic phase was established after marrow cytogenetics demonstrated the Philadelphia chromosome. Molecular studies showed a BCR-ABL1 qPCR result of 65% on the International Scale. Imatinib therapy at 400 mg daily was initiated due to patient preference, with achievement of complete hematological response after 4 weeks of therapy. BCR-ABL1 at 1 and 3 months after starting therapy was 37% and 13%, respectively (all reported on International Scale). Is this considered an adequate molecular response? Learning Objective• To be aware of the importance of early response monitoring for CML-CP patients treated with TKI therapy and implications for long-term outcomes.

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Section: Discussionmentioning

confidence: 99%

Prognostic significance of early molecular response in chronic myeloid leukemia patients treated with tyrosine kinase inhibitors

Yeung

Mauro

2014

Hematology

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“…According to ELN guidelines BCR-ABL transcript level >10% entitles us to change of imatinib therapy on TKI second generation [8]. Future directions for us will focus on the possibility of discontinuation of TKI therapy and potential cure of CML [9].…”

Section: Targeted Therapy In Chronic Myeloid Leukemiamentioning

confidence: 99%

Advances in hematology – research that revolutionized patient care

Wach

Podhorecka

Cioch³

et al. 2015

Polish Journal of Public Health

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Advances in hematology -research that revolutionized patient care AbstractIn the last decades, substantial strides have been made in the diagnosis, treatment, and prevention of blood diseases. The new drugs to be used in combination with cytostatic therapy have been developed, based on increased understanding of the biology of neoplasia. The diagnosis of several diseases is based exclusively on cytogenetic and molecular analysis which has become a part of routine diagnostic management. Moreover, molecular definition has allowed the introduction of therapy targeted at molecular change characteristic for a given disease. The introduction of novel agents for the treatment of hematological disorders has resulted in a great improvement in response rate and median survival.The aim of this study is to show advances and possible future directions in the treatment of chosen hematological malignancies during the recent decades.

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“…43 In a recent evidence-based mini review presented at the American Society of Hematology meeting in 2013, seven prospective and two retrospective trials were analyzed; it was concluded that selected patients, perhaps half of them, may remain treatment-free for a long period of time. 44 The information in relation to dasatinib and noilotinib discontinuation in CML-CP is limited, 45 but since these drugs are more potent than imatinib and capable of producing higher CMR rates, it is reasonable to expect similar or better long-term results after discontinuation of these second-generation TKI. We can assume that cure is possible in a subset of CML patients, but further identification of this subgroup is necessary.…”

Section: Tki Treatment Expectationsmentioning

confidence: 99%

The treatment of CML at an environment with limited resources

et al. 2016

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With the start of the new millennium, the International Randomized Study of Interferon-α plus cytarabine versus STI571 (IRIS) trial demonstrated a dramatic improvement in survival by comparing imatinib versus interferon alpha plus cytarabine. The Food and Drug Administration (FDA) approved imatinib as first-line treatment for newly diagnosed CML in 2001 due to its outstanding effectiveness. Years later, three second-generation (dasatinib, nilotinib, bosutinib) and one third-generation (ponatinib) tyrosine-kinase inhibitors (TKIs) were developed and approved. These highly effective treatment options, however, are not affordable for many low-income patients. Additionally, the use of drugs that effectively treat but do not cure the disease has resulted in an important economic impact for patients and health care systems worldwide, especially those in developing countries. Imatinib is the least expensive and a very effective TKI in many low-income countries. Early allogeneic stem cell transplantation must be considered in the management of selected patients before CML transformation.

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Discontinuation of tyrosine kinase inhibitors in chronic myeloid leukemia: when is this a safe option to consider?

Cited by 12 publications

References 35 publications

Prognostic significance of early molecular response in chronic myeloid leukemia patients treated with tyrosine kinase inhibitors

Prognostic significance of early molecular response in chronic myeloid leukemia patients treated with tyrosine kinase inhibitors

Advances in hematology – research that revolutionized patient care

The treatment of CML at an environment with limited resources

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