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. 2022 Mar 3:12:839915.
doi: 10.3389/fonc.2022.839915. eCollection 2022.

Treatment-Free Remission in Chronic Myeloid Leukemia Patients Treated With Low-Dose TKIs: A Feasible Option Also in the Real-Life. A Campus CML Study

Alessandra Iurlo  1 , Daniele Cattaneo  1   2 , Silvia Artuso  1 , Dario Consonni  3 , Elisabetta Abruzzese  4 , Gianni Binotto  5 , Monica Bocchia  6 , Massimiliano Bonifacio  7 , Fausto Castagnetti  8 , Sara Galimberti  9 , Antonella Gozzini  10 , Miriam Iezza  8 , Roberto Latagliata  11 , Luigiana Luciano  12 , Alessandro Maggi  13 , Maria Cristina Miggiano  14 , Patrizia Pregno  15 , Giovanna Rege-Cambrin  16 , Sabina Russo  17 , Anna Rita Scortechini  18 , Agostino Tafuri  19 , Mario Tiribelli  20 , Carmen Fava  21 , Gianantonio Rosti  22 , Robin Foa  23 , Massimo Breccia  23 , Giuseppe Saglio  21
Affiliations

Treatment-Free Remission in Chronic Myeloid Leukemia Patients Treated With Low-Dose TKIs: A Feasible Option Also in the Real-Life. A Campus CML Study

Alessandra Iurlo et al. Front Oncol. .

Abstract

Treatment-free remission (TFR) has become a primary therapeutic goal in CML and is also considered feasible by international guidelines. TKIs dose reduction is often used in real-life practice to reduce adverse events, although its impact on TFR is still a matter of debate. This study aimed to explore the attitude of Italian hematologists towards prescribing TKIs at reduced doses and its impact on TFR. In September 2020, a questionnaire was sent to 54 hematology centers in Italy participating to the Campus CML network. For each patient, data on the main disease characteristics were collected. Most of the hematologists involved (64.4%) believed that low-dose TKIs should not influence TFR. Indeed, this approach was offered to 194 patients. At the time of TFR, all but 3 patients had already achieved a DMR, with a median duration of 61.0 months. After a median follow-up of 29.2 months, 138 (71.1%) patients were still in TFR. Interestingly, TFR outcome was not impaired by any of the variables examined, including sex, risk scores, BCR-ABL1 transcript types, previous interferon, type and number of TKIs used before treatment cessation, degree of DMR or median duration of TKIs therapy. On the contrary, TFR was significantly better after dose reduction due to AEs; furthermore, patients with a longer DMR duration showed a trend towards prolonged TFR. This survey indicates that low-dose TKI treatment is an important reality. While one third of Italian hematologists still had some uncertainties on TFR feasibility after using reduced doses of TKIs outside of clinical trials, TFR has often been considered a safe option even in patients treated with low-dose TKIs in the real-life setting. It should be noted that only 28.9% of our cases had a molecular recurrence, less than reported during standard dose treatment. Consequently, TFR is not impaired using low-dose TKIs.

Keywords: adverse event (AE); chronic myeloid leukemia; low dose; real life; treatment-free remission (TFR); tyrosine kinase inhibitors (TKI).

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Treatment-free remission (TFR) after tyrosine kinase inhibitor (TKI) therapy (Kaplan-Meier estimate).
Figure 2
Figure 2
Treatment-free remission (TFR) after tyrosine kinase inhibitor (TKI) therapy (Kaplan-Meier estimate). (A) TFR according to sex. (B) TFR according to pretreatment with interferon. (C) TFR according to Sokal risk score. (D) TFR according to TKIs used before therapy cessation.
Figure 3
Figure 3
Treatment-free remission (TFR) after tyrosine kinase inhibitor (TKI) therapy (Kaplan-Meier estimate). (A) TFR according to BCR-ABL1 transcript type. (B) TFR according to lines of therapy. (C) TFR according to median duration of TKIs therapy. (D) TFR according to median duration of DMR. (E) TFR according to the degree of DMR. (F) TFR according to the main reasons for TKIs dose reduction.
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