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Review
. 2019 Aug;14(4):337-345.
doi: 10.1007/s11899-019-00524-w.

Is There a Role for Dose Modification of TKI Therapy in CML?

M Copland  1
Affiliations
Review

Is There a Role for Dose Modification of TKI Therapy in CML?

M Copland. Curr Hematol Malig Rep. 2019 Aug.

Abstract

Purpose of review: For patients with chronic phase chronic myeloid leukemia (CP-CML), there is an increasing focus on personalization of therapy with dose modifications of tyrosine kinase inhibitors (TKIs) to reduce side effects and maintain efficacy. Dose reductions are also being considered in clinical trials prior to treatment-free remission (TFR) attempts.

Recent findings: Recent retrospective analyses of large clinical trials show that dose modification/reduction is safe. Efficacy is generally maintained and side effects are improved. Clinical trials such as DESTINY have demonstrated that dose reduction is safe for patients in deep molecular remission and may be considered prior to a TFR attempt. Dose modifications are widely used to prevent and manage the toxicities of TKIs. With adequate monitoring, dose optimization is safe, reduces side effects, and improves quality-of-life for patients. Clinical trials of dose optimization are currently recruiting across all approved TKIs and will lead to further personalization of therapy for CP-CML patients in the future.

Keywords: Chronic myeloid leukemia; Dose optimization; Elderly; Toxicity; Treatment-free remission; Tyrosine kinase inhibitors.

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Conflict of interest statement

M. Copland reports personal fees and other from Ariad/Incyte, personal fees and non-financial support from Novartis Pharma, personal fees and non-financial support from Bristol-Myers Squibb, and personal fees from Pfizer.

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