Chronická myeloidní leukemie - je možné terapii ukončit?
|Title in English||Chronic myeloid leukemia - is it possible to discontinue the therapy?|
|Year of publication||2020|
|Type||Article in Periodical|
|Magazine / Source||Postgraduální medicína|
|MU Faculty or unit|
|Keywords||chronic myeloid leukemia; tyrosine kinase inhibitors; treatment discontinuation; treatment-free remission; deep molecular response; withdrawal syndrome|
|Description||Tyrosine kinase inhibitors (TKI) introduction into clinical practice has dramatically improved chronic myeloid leukemia patients prognosis with life expectancy approaching that of global population. Besides significant benefit, life-long TKI therapy brings also some obstacles namely in terms of adverse events, impaired quality of life, and economical burden. TKI discontinuation attempts carried out particularly with clinical trials have led to treatment-free remission (TFR) establishment in approximately 50% of patients with sustained deep molecular response. Safety of discontinuation attempts was confirmed by rapid molecular response re-institution in a vast majority of patients thanks to TKI re-treatment after molecular recurrence. Quite unexpected TKI withdrawal syndrome with musculoskeletal pain affected up to 40% of patients. Since TKI discontinuation has been gradually shifted into clinical practice, solving some pending issues such as factors predictive for TFR success identification, criteria for TKI cessation and re-introduction unification, highly sensitive molecular monitoring assurance, and finally previous TKI treatment optimization as well as respective TKI discontinuation approach modification in order to enable more patients to attempt TFR has been warranted. All these aspects including TKI stopping clinical trials and clinical practice experience review are presented in this manuscript.|