Patient-Initiated Discontinuation of Tyrosine Kinase Inhibitor for Chronic Myeloid Leukemia

Abstract

The introduction of tyrosine kinase inhibitors (TKI) has revolutionised the management of patients with chronic myeloid leukemia (CML) over the last twenty years, but despite significant improvements in survival, patients exhibit long-term side effects that impact on quality of life. A major advance in CML management has been the ability to discontinue TKI therapy achieving a treatment-free remission (TFR), yet this option is only available to eligible patients who present with low-risk disease and who subsequently attain deep and sustained molecular responses. A case is described of a patient with CML who self-initiated stopping of TKI therapy when in a less than optimal molecular remission. Despite this action, the patient continues to experience a TFR with prospective close molecular monitoring performed. It is emphasized that this approach may lead to ineffective treatment discontinuation, molecular relapse, and increased patient anxiety. As TFR for patients with CML moves from clinical trials into routine clinical practice, emphasis is placed on adherence to (evolving) guidelines critical to ensure optimal counselling, selection, monitoring, and continued management of patients whether TFR is successful or not.

Tyrosine kinase inhibitor treatment discontinuation in chronic myeloid leukemia: patient views

“…Optimal adherence to TKI treatment is paramount to achieving an optimal molecular response, while its depth is related to treatment duration [15][16][17]31]. Despite these requirements, awareness of the possibility of successful TKI treatment discontinuation and knowledge that in the event of relapse treatment can be successfully resumed, will encourage patients who have been treated for a long time to interrupt TKI treatment for shorter or longer periods [8,[32][33][34][35]. HCPs counseling patients on longterm TKI treatment must be aware of this paradox which also urgently requires more clarity.…”