On the road to treatment-free remission in chronic myeloid leukemia: what about 'the others'?

Abstract

Introduction: The treatment of chronic myeloid leukemia (CML) has been drastically changed by the approval of tyrosine kinase inhibitors (TKIs). CML is now managed as a chronic disease requiring both long-term treatment and close molecular monitoring in the majority of patients.

Areas covered: Evidence suggests that in a substantial number of patients who have achieved a stable deep molecular response (DMR), TKI treatment can be safely discontinued without loss of response. Therefore, treatment-free remission (TFR), through the achievement of a DMR, is increasingly regarded as a feasible treatment goal in about 20% to 40% CML patients. Nevertheless, a proportion of patients with chronic-phase CML treated with TKIs remain in stable MMR and do not achieve a DMR.

Expert opinion: We provide prospective views on how it is possible to optimize treatment for patients in stable MMR but not in DMR in order to finalize the therapeutic strategy.

Keywords: BCR-ABL1; Bosutinib; CML therapy; Chronic Myeloid Leukemia; Dasatinib; Imatinib Mesylate; Nilotinib; Ponatinib; Tyrosine Kinase Inhibitors.