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Laganà A, Scalzulli E, Bisegna ML, Carmosino I, Ielo C, Costa A, Torrieri L, Totaro M, Martelli M, Breccia M. Treatment free remission (TFR) after second-generation tyrosine kinase inhibitors (2G-TKIs) treatment in chronic myeloid leukemia (CML): from feasibility to safety. Expert Opin Drug Saf 2024:1-11. [PMID: 38873693 DOI: 10.1080/14740338.2024.2368822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/12/2024] [Indexed: 06/15/2024]
Abstract
INTRODUCTION Chronic myeloid leukemia (CML) prevalence is currently increasing due to the great efficacy of tyrosine kinase inhibitor (TKI) therapy. Discontinuation of treatment in the long-term, owing to avoid off-target side effects or treatment-free remission (TFR), has become an additional treatment goal in CML patients who achieved a deep molecular response (DMR). Second-generation TKIs (2 G-TKIs) have a significantly higher rate of DMR than imatinib. Hence, especially in young patients with a strategy of TFR, 2 G-TKIs are becoming the most frequently used TKIs and may increase TFR attempts in the future. AREAS COVERED In this review, the main findings extrapolated from clinical trials and real-life evidence regarding 2 G-TKIs discontinuation were discussed, through broad research on Medline, Embase, and archives from EHA and ASH congresses. EXPERT OPINION Overall, TFR rate after 2 G-TKIs is ranging from 40% to 60% for selected patients with sustained DMR and it can be considered a safe procedure, that have become, nowadays, a daily practice. However, many crucial aspects regarding treatment choices, timings, as well as predictive factors, patient communication, and optimal strategies need to be better clarified to improve successful TFR rate.
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Affiliation(s)
- Alessandro Laganà
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Emilia Scalzulli
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Maria Laura Bisegna
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Ida Carmosino
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Claudia Ielo
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Alessandro Costa
- Hematology Unit, Department of Medical Sciences and Public Health, Businco Hospital, University of Cagliari, Cagliari, Italy
| | - Lorenzo Torrieri
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Matteo Totaro
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Maurizio Martelli
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Massimo Breccia
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
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2
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Bonifacio M, Scaffidi L, Miggiano MC, Facchinelli D, Tosoni L, Pezone S, Griguolo D, Ciotti G, Danini M, Bernardelli A, Bresciani R, Cavraro M, Crosera L, De March E, Dell'Eva M, Dorotea L, Frison L, Furlani L, Gianesello I, Lovato E, Marchetti E, Morelli G, Mullai R, Pizzano U, Zoletto S, Fanin R, Krampera M, Trentin L, Calistri E, Carli G, Binotto G, Tiribelli M. A successful treatment-free remission is achievable also by chronic myeloid leukemia patients lacking optimal requirements. Blood Cancer J 2024; 14:53. [PMID: 38531834 DOI: 10.1038/s41408-024-01025-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/22/2024] [Accepted: 02/28/2024] [Indexed: 03/28/2024] Open
Affiliation(s)
- Massimiliano Bonifacio
- Department of Engineering for Innovation Medicine, Section of Innovation Biomedicine, Hematology Area, University of Verona and Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
| | - Luigi Scaffidi
- Department of Engineering for Innovation Medicine, Section of Innovation Biomedicine, Hematology Area, University of Verona and Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | | | - Luca Tosoni
- Division of Hematology and BMT, Azienda Sanitaria Universitaria Friuli Centrale and Department of Medical Area, University of Udine, Udine, Italy
| | - Sara Pezone
- Department of Medicine, Hematology and Clinical Immunology, University of Padua, Padova, Italy
| | - Davide Griguolo
- Hematology Unit, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste, Italy
| | - Giulia Ciotti
- Onco Hematology, Department of Oncology, Veneto Institute of Oncology, IOV-IRCCS, Padova, Italy
| | - Marco Danini
- Hematology Unit, Ca' Foncello Hospital, Treviso, Italy
| | - Andrea Bernardelli
- Department of Engineering for Innovation Medicine, Section of Innovation Biomedicine, Hematology Area, University of Verona and Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Rita Bresciani
- Department of Engineering for Innovation Medicine, Section of Innovation Biomedicine, Hematology Area, University of Verona and Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Monica Cavraro
- Department of Medicine, Oncology Unit, San Donà di Piave (VE), Italy
| | - Lara Crosera
- Department of Engineering for Innovation Medicine, Section of Innovation Biomedicine, Hematology Area, University of Verona and Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Michele Dell'Eva
- Hematology and Bone Marrow Transplant Unit, Ospedale Regionale San Maurizio, Bolzano, Italy
| | - Laura Dorotea
- Oncology Unit, Ospedali Riuniti Padova Sud-Schiavonia, Monselice (PD), Italy
| | - Luca Frison
- Hematology Unit, Ospedale Dell'Angelo, Mestre-Venezia, Italy
| | - Lara Furlani
- Oncology Unit, Ospedale Mater Salutis, Legnago (VR), Italy
| | - Ilaria Gianesello
- Department of Medicine, Hematology and Clinical Immunology, University of Padua, Padova, Italy
| | - Ester Lovato
- Department of Engineering for Innovation Medicine, Section of Innovation Biomedicine, Hematology Area, University of Verona and Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Elena Marchetti
- Department of Engineering for Innovation Medicine, Section of Innovation Biomedicine, Hematology Area, University of Verona and Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Gianluca Morelli
- Division of Hematology and BMT, Azienda Sanitaria Universitaria Friuli Centrale and Department of Medical Area, University of Udine, Udine, Italy
| | - Rikard Mullai
- Division of Hematology and BMT, Azienda Sanitaria Universitaria Friuli Centrale and Department of Medical Area, University of Udine, Udine, Italy
| | - Umberto Pizzano
- Division of Hematology and BMT, Azienda Sanitaria Universitaria Friuli Centrale and Department of Medical Area, University of Udine, Udine, Italy
| | - Simone Zoletto
- Department of Medicine, Hematology and Clinical Immunology, University of Padua, Padova, Italy
| | - Renato Fanin
- Division of Hematology and BMT, Azienda Sanitaria Universitaria Friuli Centrale and Department of Medical Area, University of Udine, Udine, Italy
| | - Mauro Krampera
- Department of Engineering for Innovation Medicine, Section of Innovation Biomedicine, Hematology Area, University of Verona and Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Livio Trentin
- Department of Medicine, Hematology and Clinical Immunology, University of Padua, Padova, Italy
| | - Elisabetta Calistri
- Onco Hematology, Department of Oncology, Veneto Institute of Oncology, IOV-IRCCS, Padova, Italy
| | - Giuseppe Carli
- Department of Hematology, San Bortolo Hospital, Vicenza, Italy
| | - Gianni Binotto
- Department of Medicine, Hematology and Clinical Immunology, University of Padua, Padova, Italy
| | - Mario Tiribelli
- Division of Hematology and BMT, Azienda Sanitaria Universitaria Friuli Centrale and Department of Medical Area, University of Udine, Udine, Italy
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Laganà A, Pepe S, Scalzulli E, Carmosino I, Passucci M, Ielo C, Costa A, Masucci C, Diverio D, Martelli M, Breccia M. One-month qRT-PCR BCR::ABL1 transcript threshold to predict early recurrence in chronic phase CML patients attempting first treatment free remission. Eur J Haematol 2023; 111:970-972. [PMID: 37587772 DOI: 10.1111/ejh.14085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 08/18/2023]
Affiliation(s)
- Alessandro Laganà
- Hematology, Department of Translational and Precision Medicine, Policlinico Umberto I-Sapienza University, Rome, Italy
| | - Sara Pepe
- Hematology, Department of Translational and Precision Medicine, Policlinico Umberto I-Sapienza University, Rome, Italy
| | - Emilia Scalzulli
- Hematology, Department of Translational and Precision Medicine, Policlinico Umberto I-Sapienza University, Rome, Italy
| | - Ida Carmosino
- Hematology, Department of Translational and Precision Medicine, Policlinico Umberto I-Sapienza University, Rome, Italy
| | - Mauro Passucci
- Hematology, Department of Translational and Precision Medicine, Policlinico Umberto I-Sapienza University, Rome, Italy
| | - Claudia Ielo
- Hematology, Department of Translational and Precision Medicine, Policlinico Umberto I-Sapienza University, Rome, Italy
| | - Alessandro Costa
- Hematology, Department of Translational and Precision Medicine, Policlinico Umberto I-Sapienza University, Rome, Italy
| | - Chiara Masucci
- Hematology, Department of Translational and Precision Medicine, Policlinico Umberto I-Sapienza University, Rome, Italy
| | - Daniela Diverio
- Hematology, Department of Translational and Precision Medicine, Policlinico Umberto I-Sapienza University, Rome, Italy
| | - Maurizio Martelli
- Hematology, Department of Translational and Precision Medicine, Policlinico Umberto I-Sapienza University, Rome, Italy
| | - Massimo Breccia
- Hematology, Department of Translational and Precision Medicine, Policlinico Umberto I-Sapienza University, Rome, Italy
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Marin AM, Wosniaki DK, Sanchuki HBS, Munhoz EC, Nardin JM, Soares GS, Espinace DC, de Holanda Farias JS, Veroneze B, Becker LF, Costa GL, Beltrame OC, de Oliveira JC, Cambri G, Zanette DL, Aoki MN. Molecular BCR::ABL1 Quantification and ABL1 Mutation Detection as Essential Tools for the Clinical Management of Chronic Myeloid Leukemia Patients: Results from a Brazilian Single-Center Study. Int J Mol Sci 2023; 24:10118. [PMID: 37373266 DOI: 10.3390/ijms241210118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/23/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Chronic myeloid leukemia (CML) is a well-characterized oncological disease in which virtually all patients possess a translocation (9;22) that generates the tyrosine kinase BCR::ABL1 protein. This translocation represents one of the milestones in molecular oncology in terms of both diagnostic and prognostic evaluations. The molecular detection of the BCR::ABL1 transcription is a required factor for CML diagnosis, and its molecular quantification is essential for assessing treatment options and clinical approaches. In the CML molecular context, point mutations on the ABL1 gene are also a challenge for clinical guidelines because several mutations are responsible for tyrosine kinase inhibitor resistance, indicating that a change may be necessary in the treatment protocol. So far, the European LeukemiaNet and the National Comprehensive Cancer Network (NCCN) have presented international guidelines on CML molecular approaches, especially those related to BCR::ABL1 expression. In this study, we show almost three years' worth of data regarding the clinical treatment of CML patients at the Erasto Gaertner Hospital, Curitiba, Brazil. These data primarily comprise 155 patients and 532 clinical samples. BCR::ABL1 quantification by a duplex-one-step RT-qPCR and ABL1 mutations detection were conducted. Furthermore, digital PCR for both BCR::ABL1 expression and ABL1 mutations were conducted in a sub-cohort. This manuscript describes and discusses the clinical importance and relevance of molecular biology testing in Brazilian CML patients, demonstrating its cost-effectiveness.
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Affiliation(s)
- Anelis Maria Marin
- Laboratory for Applied Science and Technology in Health, Carlos Chagas Institute, Oswaldo Cruz Foundation (Fiocruz), Curitiba 81350-010, Brazil
| | - Denise Kusma Wosniaki
- Laboratory for Applied Science and Technology in Health, Carlos Chagas Institute, Oswaldo Cruz Foundation (Fiocruz), Curitiba 81350-010, Brazil
| | - Heloisa Bruna Soligo Sanchuki
- Laboratory for Applied Science and Technology in Health, Carlos Chagas Institute, Oswaldo Cruz Foundation (Fiocruz), Curitiba 81350-010, Brazil
| | | | | | - Gabriela Silva Soares
- Laboratory for Applied Science and Technology in Health, Carlos Chagas Institute, Oswaldo Cruz Foundation (Fiocruz), Curitiba 81350-010, Brazil
| | - Dhienifer Caroline Espinace
- Laboratory for Applied Science and Technology in Health, Carlos Chagas Institute, Oswaldo Cruz Foundation (Fiocruz), Curitiba 81350-010, Brazil
| | | | | | | | | | | | | | - Geison Cambri
- Instituto de Biologia Molecular do Paraná (IBMP), Curitiba 81350-010, Brazil
| | - Dalila Luciola Zanette
- Laboratory for Applied Science and Technology in Health, Carlos Chagas Institute, Oswaldo Cruz Foundation (Fiocruz), Curitiba 81350-010, Brazil
| | - Mateus Nóbrega Aoki
- Laboratory for Applied Science and Technology in Health, Carlos Chagas Institute, Oswaldo Cruz Foundation (Fiocruz), Curitiba 81350-010, Brazil
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Tiribelli M, Toffoletti E, Di Giusto S, Fanin R, Damiani D. Optimal timing of molecular monitoring after tyrosine kinase inhibitor discontinuation in chronic myeloid leukemia. Eur J Haematol 2023; 110:330-331. [PMID: 36458956 DOI: 10.1111/ejh.13907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/24/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Mario Tiribelli
- Division of Hematology and Bone Marrow Transplantation, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.,Department of Medical Area, University of Udine, Udine, Italy
| | - Eleonora Toffoletti
- Division of Hematology and Bone Marrow Transplantation, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.,Department of Medical Area, University of Udine, Udine, Italy
| | - Sara Di Giusto
- Division of Hematology and Bone Marrow Transplantation, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Renato Fanin
- Division of Hematology and Bone Marrow Transplantation, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.,Department of Medical Area, University of Udine, Udine, Italy
| | - Daniela Damiani
- Division of Hematology and Bone Marrow Transplantation, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.,Department of Medical Area, University of Udine, Udine, Italy
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