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Chelysheva EY, Petrova AN, Shukhov OA, Bykova AV, Nemchenko IS, Gurianova MA, Tsyba NN, Turkina AG. Withdrawal syndrome after tyrosine kinase inhibitors discontinuation in patients with chronic myeloid leukemia. TERAPEVT ARKH 2022; 94:836-843. [DOI: 10.26442/00403660.2022.07.201747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 08/11/2022] [Indexed: 11/22/2022]
Abstract
Background. Withdrawal syndrome (WS) a musculoskeletal pain after discontinuation of tyrosine kinase inhibitors (TKI) in patients with chronic myeloid leukemia (CML) has been described in the treatment-free remission (TFR) studies. The pathophysiological mechanisms and predisposing factors of WS have not been well established.
Aim. Our aim was to evaluate clinical features and factors associated with WS in the Russian cohort of CML patients who discontinued TKI therapy.
Materials and methods. WS was evaluated in total of 183 CML patients with chronic phase and sustained deep molecular response (DMR). WS was defined as a musculoskeletal pain newly observed after TKI cessation or as a worsening of previously observed symptoms.
Results. DMR loss free survival at 36 months was 49% and 43% in prospective and retrospective groups respectively (p=0.96) with mеdian (Me) time of observation 33 months (range 1136). WS was observed in 49 (27%) patients: grade 12 was in 45 (92%) patients, grade 3 in 4 (8%) patients. Me time to WS occurrence was 2 months (range 17), Ме duration of WS was 5 months (range 135). WS was resolved in 14 of 15 patients with molecular relapse after 13 months of TKI re-initiation and was decreased in 1 patient. WS was completely resolved in 31 of 34 patients who continued remained in TFR and decreased in 3 patients. WS was resolved spontaneously or with nonsteroidal anti-inflammatory drugs in 14 (45%) and 17 (55%) patients accordingly. Older age (p0.0001), longer duration of TKI therapy (p0.0001) and presence of locomotion system diseases (p=0.022) were observed in patients with WS. No WS was observed in pregnant patients (р0.001). Survival without DMR loss at 12 months after TKI stop was 66 and 42% in patients with and without WS accordingly (р=0.095).
Conclusion. The rate of WS was 27% that is in a good concordance with the data of the other TFR studies. A longer period of TKI exposure, older age and the history of locomotion system diseases were associated with the development of the WS. We found for the first time that WS was not observed in patients with pregnancy. There was no association of WS development and the rate of molecular relapses.
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Petrova A, Chelysheva E, Shukhov O, Bykova A, Nemchenko I, Gusarova G, Tsyba N, Julhakyan H, Shuvaev V, Fominykh M, Martynkevich I, Ionova T, Turkina A. Withdrawal Syndrome After Tyrosine Kinase Inhibitor Discontinuation in Patients With Chronic Myeloid Leukemia in the Russian Prospective Study RU-SKI. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:267-271. [PMID: 32146103 DOI: 10.1016/j.clml.2019.12.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/26/2019] [Accepted: 12/30/2019] [Indexed: 01/01/2023]
Abstract
We aimed to characterize withdrawal syndrome (WS) and evaluate factors associated with its development in the prospective clinical study RU-SKI in patients with chronic myeloid leukemia with deep molecular response who discontinued tyrosine kinase inhibitor (TKI) therapy. In total, 98 adult patients with chronic myeloid leukemia chronic phase, TKI therapy ≥ 3 years, and deep molecular response (BCR-ABL ≤ 0.01%) ≥ 2 years were enrolled and observed without treatment. WS was defined as newly observed or worsening musculoskeletal pain after TKI cessation. WS symptoms were found in 41 (42%) of 98 patients with a median time of observation of 25 months (range, 12-42 months). WS grades 1 to 2 and grade 3 were observed in 39 (95%) and in 2 (5%) patients, respectively. The median duration of WS was 5 months (range, 1-25 months). WS was resolved in 37 (90%) patients. Anti-inflammatory therapy was used in 21 (51%) patients. Older age (P = .039) and longer TKI therapy (P = .001) were associated with WS. The 2-month landmark analysis found no association of WS development and the rate of molecular relapses. In total, 42% of the patients experienced WS after TKI therapy discontinuation in the RU-SKI study. Physicians should be warned about the possibility of WS development, and patients of older age and with longer TKI treatment need special attention.
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Affiliation(s)
- Anna Petrova
- Scientific and Advisory Department of Chemotherapy of Myeloproliferative Disorders, National Research Center for Hematology, Moscow, Russian Federation
| | - Ekaterina Chelysheva
- Scientific and Advisory Department of Chemotherapy of Myeloproliferative Disorders, National Research Center for Hematology, Moscow, Russian Federation
| | - Oleg Shukhov
- Scientific and Advisory Department of Chemotherapy of Myeloproliferative Disorders, National Research Center for Hematology, Moscow, Russian Federation
| | - Anastasiya Bykova
- Scientific and Advisory Department of Chemotherapy of Myeloproliferative Disorders, National Research Center for Hematology, Moscow, Russian Federation
| | - Irina Nemchenko
- Scientific and Advisory Department of Chemotherapy of Myeloproliferative Disorders, National Research Center for Hematology, Moscow, Russian Federation
| | - Galina Gusarova
- Scientific and Advisory Department of Chemotherapy of Myeloproliferative Disorders, National Research Center for Hematology, Moscow, Russian Federation
| | - Nikolay Tsyba
- Scientific and Advisory Department of Chemotherapy of Myeloproliferative Disorders, National Research Center for Hematology, Moscow, Russian Federation
| | - Hunan Julhakyan
- Scientific and Advisory Department of Chemotherapy of Myeloproliferative Disorders, National Research Center for Hematology, Moscow, Russian Federation.
| | - Vasiliy Shuvaev
- Russian Research Institute of Hematology and Transfusiology, Federal Biomedical Agency of Russia, Saint-Petersburg, Russian Federation; City Clinical Hospital n.a. V.V. Veresaev of the Moscow Department of Healthcare, Moscow, Russian Federation
| | - Mikhail Fominykh
- Russian Research Institute of Hematology and Transfusiology, Federal Biomedical Agency of Russia, Saint-Petersburg, Russian Federation; Academic Chair of Hospital Therapy, Saint-Petersburg State University, Saint-Petersburg, Russian Federation
| | - Irina Martynkevich
- Russian Research Institute of Hematology and Transfusiology, Federal Biomedical Agency of Russia, Saint-Petersburg, Russian Federation
| | - Tatyana Ionova
- Chair of Quality of Life Unit, Saint-Petersburg State University Hospital, Saint Petersburg, Russian Federation; Quality of Life Monitoring Department, Multinational Center for Quality of Life Research, Saint Petersburg, Russian Federation
| | - Anna Turkina
- Scientific and Advisory Department of Chemotherapy of Myeloproliferative Disorders, National Research Center for Hematology, Moscow, Russian Federation
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