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Blay JY, Schiffler C, Bouché O, Brahmi M, Duffaud F, Toulmonde M, Landi B, Lahlou W, Pannier D, Bompas E, Bertucci F, Chaigneau L, Collard O, Pracht M, Henon C, Ray-Coquard I, Armoun K, Salas S, Spalato-Ceruso M, Adenis A, Verret B, Penel N, Moreau-Bachelard C, Italiano A, Dufresne A, Metzger S, Chabaud S, Perol D, Le Cesne A. A randomized study of 6 versus 3 years of adjuvant imatinib in patients with localized GIST at high risk of relapse. Ann Oncol 2024:S0923-7534(24)03924-3. [PMID: 39241959 DOI: 10.1016/j.annonc.2024.08.2343] [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: 07/19/2024] [Revised: 08/22/2024] [Accepted: 08/27/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND The administration of adjuvant imatinib during 3 years is indicated after resection of primary localized GIST at high risk of recurrence, but many patients relapse afterwards. METHODS IMADGIST (NCT02260505) was a multicenter, open-label, randomized phase III study evaluating the maintenance of imatinib for 3 more years (6-year arm) compared with interruption (3-year arm) from the day of randomization, conducted in the French Sarcoma Group. The primary endpoint was intent-to-treat disease-free survival. Secondary endpoints included overall survival, time to imatinib resistance, response after imatinib reintroduction at relapse, and safety. RESULTS From 24 December 2014 to 4 April 2023, 136 patients aged ≥18 years, Eastern Cooperative Oncology Group performance status ≤2, with a localized gastrointestinal stromal tumor with an R0 or R1 surgery, and a risk of tumor recurrence ≥35% according to National Comprehensive Cancer Network (NCCN) risk classification were randomized in 14 centers. Sixty-five patients were randomized to the 3-year arm versus 71 to the 6-year arm. There were 68 males and females. Primary sites were gastric and small bowel in 60 (44%) and 64 (47%) patients, respectively. Respectively, 52 (38%) and 71 (52%) patients had a risk of relapse of 35%-70% and >70%. With a median follow-up of 55 months (interquartile range 46-59 months) after randomization, disease-free survival was significantly superior in the 6-year arm [hazard ratio: 0.40 (0.20-0.69), P = 0.0008]. Time to imatinib resistance, survival, adverse events, and quality of life were not different in the two arms. CONCLUSIONS Three additional years of adjuvant imatinib reduces the risk of relapse in patients who have received 3 years of adjuvant imatinib with an acceptable tolerance.
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Affiliation(s)
- J-Y Blay
- Centre Léon Bérard & Université Claude Bernard Lyon I, Lyon, France.
| | - C Schiffler
- Centre Léon Bérard & Université Claude Bernard Lyon I, Lyon, France
| | - O Bouché
- CHU & Université de Reims, Reims, France
| | - M Brahmi
- Centre Léon Bérard & Université Claude Bernard Lyon I, Lyon, France
| | - F Duffaud
- Hôpital La Timone & Université Aix-Marseille, Marseille, France
| | | | - B Landi
- Hôpital Européen George Pompidou, Paris, France
| | - W Lahlou
- Hôpital Européen George Pompidou, Paris, France
| | - D Pannier
- Centre Oscar Lambret & Université Lille, Lille, France
| | - E Bompas
- Institut Cancérologie de l'Ouest, Nantes, France
| | - F Bertucci
- Institut Paoli-Calmette & Université Aix-Marseille, Marseille, France
| | | | - O Collard
- Hôpital Privé de la Loire, Saint-Etienne, France
| | - M Pracht
- Centre Eugene Marquis, Rennes, France
| | - C Henon
- Institut Gustave Roussy, Villejuif, France
| | - I Ray-Coquard
- Centre Léon Bérard & Université Claude Bernard Lyon I, Lyon, France
| | - K Armoun
- CHU & Université de Reims, Reims, France
| | - S Salas
- Hôpital La Timone & Université Aix-Marseille, Marseille, France
| | | | - A Adenis
- Centre Oscar Lambret & Université Lille, Lille, France; Institut de Cancerologie de Montpellier & CLCC Val d'Aurelle, Montpellier, France
| | - B Verret
- Institut de Cancerologie de Montpellier & CLCC Val d'Aurelle, Montpellier, France
| | - N Penel
- Centre Oscar Lambret & Université Lille, Lille, France
| | | | | | - A Dufresne
- Centre Léon Bérard & Université Claude Bernard Lyon I, Lyon, France
| | - S Metzger
- Centre Léon Bérard & Université Claude Bernard Lyon I, Lyon, France
| | - S Chabaud
- Centre Léon Bérard & Université Claude Bernard Lyon I, Lyon, France
| | - D Perol
- Centre Léon Bérard & Université Claude Bernard Lyon I, Lyon, France
| | - A Le Cesne
- Institut Gustave Roussy, Villejuif, France
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2
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Efficace F, Mahon FX, Richter J, Piciocchi A, Cipriani M, Nicolini FE, Mayer J, Zackova D, Janssen JJWM, Panayiotidis P, Vestergaard H, Koskenvesa P, Almeida A, Hjorth-Hansen H, Martinez-Lopez J, Olsson-Strömberg U, Hochhaus A, Berger MG, Etienne G, Klamova H, Faber E, Rousselot P, Pfirrmann M, Saussele S. Health-related quality of life and symptoms of chronic myeloid leukemia patients after discontinuation of tyrosine kinase inhibitors: results from the EURO-SKI Trial. Leukemia 2024; 38:1722-1730. [PMID: 38987274 DOI: 10.1038/s41375-024-02341-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/26/2024] [Accepted: 07/03/2024] [Indexed: 07/12/2024]
Abstract
Limited data is available on the health-related quality of life (HRQoL) and symptoms of patients with chronic myeloid leukemia (CML) who are in treatment-free remission (TFR). We herein report HRQoL results from the EURO-SKI trial. Patients who had been on tyrosine kinase inhibitors (TKIs) therapy for at least 3 years and achieved MR4 for at least 1 year were enrolled from 11 European countries, and the EORTC QLQ-C30 and the FACIT-Fatigue questionnaires were used to assess HRQoL and fatigue respectively. Patients were categorized into the following age groups: 18-39, 40-59, 60-69 and ≥70 years. Of 728 patients evaluated at baseline, 686 (94%) completed HRQoL assessments. The median age at TKI discontinuation was 60 years. Our findings indicate that HRQoL and symptom trajectories may vary depending on specific age groups, with younger patients benefiting the most. Improvements in patients aged 60 years or older were marginal across several HRQoL and symptom domains. At the time of considering TKI discontinuation, physicians could inform younger patients that they may expect valuable HRQoL benefits. Considering the marginal improvements observed in patients aged 60 years or above, it may be important to further investigate the value of TFR compared to a lowest effective dose approach in this older group of patients.
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Affiliation(s)
- Fabio Efficace
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Haematologic Diseases (GIMEMA), Rome, Italy.
| | - Francois-Xavier Mahon
- Bergonié Cancer Institute, INSERM UMR1312 Inserm, University of Bordeaux, Bordeaux, France
| | - Johan Richter
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Alfonso Piciocchi
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Haematologic Diseases (GIMEMA), Rome, Italy
| | - Marta Cipriani
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Haematologic Diseases (GIMEMA), Rome, Italy
- Department of Statistical Sciences, Sapienza University of Rome, Rome, Italy
| | - Franck E Nicolini
- Centre Léon Bérard, Service d'Hématologie Clinique & INSERM U1052 CRCL, Lyon, France
| | - Jiri Mayer
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Daniela Zackova
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | | | | | - Hanne Vestergaard
- Department of Haematology, Odense University Hospital, Odense, Denmark
| | - Perttu Koskenvesa
- Hematology Research Unit Helsinki and HUS Cancer Center, Hematology Line, Helsinki, Finland
| | - Antonio Almeida
- Faculdade de Medicina, Universidade Católica Portuguesa, Lisbon, Portugal
- Hospital da Luz, Lisbon, Portugal
| | | | - Joaquin Martinez-Lopez
- Hospital 12 de Octubre, CNIO, i+12, Department of Medicine Univ. Complutense, Madrid, Spain
| | - Ulla Olsson-Strömberg
- Department of Medical Sciences, Uppsala University and Hematology Section, Uppsala University Hospital, Uppsala, Sweden
| | - Andreas Hochhaus
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Marc G Berger
- CHU Clermont-Ferrand, Hematology department, and EA 7453 CHELTER, University Clermont Auvergne, Clermont-Ferrand, France
| | - Gabriel Etienne
- Institut Bergonié, département d'hématologie, Bordeaux, France
- France Intergroupe de la leucémie myéloïde chronique Fi-LMC, Lyon, France
| | - Hana Klamova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Edgar Faber
- Department of Hemato-oncology, Faculty Hospital and Faculty of Medicine and Dentistry, Palacký University, Olomouc, Olomouc, Czech Republic
| | - Philippe Rousselot
- Centre Hospitalier de Versailles, Department of Haematology, University Versailles Paris-Saclay, Le Chesnay, France
| | - Markus Pfirrmann
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Medizinische Fakultät, LMU München, München, Germany
| | - Susanne Saussele
- Medical Clinic, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Wang Y, Liang ZJ, Gale RP, Liao HZ, Ma J, Gong TJ, Shao YQ, Liang Y. Chronic myeloid leukaemia: Biology and therapy. Blood Rev 2024; 65:101196. [PMID: 38604819 DOI: 10.1016/j.blre.2024.101196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/13/2024]
Abstract
Chronic myeloid leukaemia (CML) is caused by BCR::ABL1. Tyrosine kinase-inhibitors (TKIs) are the initial therapy. Several organizations have reported milestones to evaluate response to initial TKI-therapy and suggest when a change of TKI should be considered. Achieving treatment-free remission (TFR) is increasingly recognized as the optimal therapy goal. Which TKI is the best initial therapy for which persons and what depth and duration of molecular remission is needed to achieve TFR are controversial. In this review we discuss these issues and suggest future research directions.
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MESH Headings
- Humans
- Protein Kinase Inhibitors/therapeutic use
- Fusion Proteins, bcr-abl/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/etiology
- Remission Induction
- Biology
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Affiliation(s)
- Yun Wang
- Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Centre for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Zhi-Jian Liang
- Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Centre for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Robert Peter Gale
- Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Centre for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; Centre for Haematology, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Hua-Ze Liao
- Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Centre for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Jun Ma
- Harbin Institute of Hematology and Oncology, Harbin First Hospital, Harbin 150010, China
| | - Tie-Jun Gong
- Harbin Institute of Hematology and Oncology, Harbin First Hospital, Harbin 150010, China.
| | - Ying-Qi Shao
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China.
| | - Yang Liang
- Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Centre for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China.
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Kwaśnik P, Zaleska J, Link-Lenczowska D, Zawada M, Wysogląd H, Ochrem B, Bober G, Wasilewska E, Hus I, Szarejko M, Prejzner W, Grzybowska-Izydorczyk O, Klonowska-Szymczyk A, Mędraś E, Kiełbus M, Sacha T, Giannopoulos K. High Level of CD8 +PD-1 + Cells in Patients with Chronic Myeloid Leukemia Who Experienced Loss of MMR after Imatinib Discontinuation. Cells 2024; 13:723. [PMID: 38667336 PMCID: PMC11048908 DOI: 10.3390/cells13080723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/12/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
Treatment-free remission (TFR) is achieved in approximately half of chronic myeloid leukemia (CML) patients treated with tyrosine kinase inhibitors. The mechanisms responsible for TFR maintenance remain elusive. This study aimed to identify immune markers responsible for the control of residual CML cells early in the TFR (at 3 months), which may be the key to achieving long-term TFR and relapse-free survival (RFS) after discontinuation of imatinib. Our study included 63 CML patients after imatinib discontinuation, in whom comprehensive analysis of changes in the immune system was performed by flow cytometry, and changes in the BCR::ABL1 transcript levels were assessed by RQ-PCR and ddPCR. We demonstrated a significant increase in the percentage of CD8+PD-1+ cells in patients losing TFR. The level of CD8+PD-1+ cells is inversely related to the duration of treatment and incidence of deep molecular response (DMR) before discontinuation. Analysis of the ROC curve showed that the percentage of CD8+PD-1+ cells may be a significant factor in early molecular recurrence. Interestingly, at 3 months of TFR, patients with the e13a2 transcript had a significantly higher proportion of the PD-1-expressing immune cells compared to patients with the e14a2. Our results suggest the important involvement of CD8+PD-1+ cells in the success of TFR and may help in identifying a group of patients who could successfully discontinue imatinib.
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MESH Headings
- Humans
- Imatinib Mesylate/therapeutic use
- Imatinib Mesylate/pharmacology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- CD8-Positive T-Lymphocytes/immunology
- CD8-Positive T-Lymphocytes/drug effects
- Female
- Male
- Middle Aged
- Adult
- Programmed Cell Death 1 Receptor/metabolism
- Programmed Cell Death 1 Receptor/antagonists & inhibitors
- Aged
- Fusion Proteins, bcr-abl/genetics
- Fusion Proteins, bcr-abl/metabolism
- Young Adult
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Affiliation(s)
- Paulina Kwaśnik
- Department of Experimental Hematooncology, Medical University of Lublin, 20-093 Lublin, Poland; (P.K.)
| | - Joanna Zaleska
- Department of Experimental Hematooncology, Medical University of Lublin, 20-093 Lublin, Poland; (P.K.)
| | - Dorota Link-Lenczowska
- Department of Hematology Diagnostics, Jagiellonian University Hospital in Kraków, 30-688 Kraków, Poland
| | - Magdalena Zawada
- Department of Hematology Diagnostics, Jagiellonian University Hospital in Kraków, 30-688 Kraków, Poland
| | - Hubert Wysogląd
- Department of Hematology, Jagiellonian University Hospital in Kraków, 30-688 Kraków, Poland
| | - Bogdan Ochrem
- Department of Hematology, Jagiellonian University Hospital in Kraków, 30-688 Kraków, Poland
| | - Grażyna Bober
- Department of Hematooncology and Bone Marrow Transplantation, School of Medicine in Katowice, Medical University of Silesia, 40-032 Katowice, Poland
| | - Ewa Wasilewska
- Department of Hematology, Medical University of Białystok, 15-276 Białystok, Poland
| | - Iwona Hus
- Department of Hematology, Institute of Hematology and Transfusion Medicine, 02-776 Warsaw, Poland
- Department of Clinical Transplantology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Monika Szarejko
- Department of Hematology and Transplantology, Medical University of Gdańsk, 80-214 Gdańsk, Poland
| | - Witold Prejzner
- Department of Hematology and Transplantology, Medical University of Gdańsk, 80-214 Gdańsk, Poland
| | | | | | - Ewa Mędraś
- Department of Hematology, Neoplastic Blood Disorders and Bone Marrow Transplantation in Wrocław, 50-367 Wrocław, Poland
| | - Michał Kiełbus
- Department of Experimental Hematooncology, Medical University of Lublin, 20-093 Lublin, Poland; (P.K.)
| | - Tomasz Sacha
- Chair of Hematology, Jagiellonian University Medical College in Kraków, 31-501 Kraków, Poland
| | - Krzysztof Giannopoulos
- Department of Experimental Hematooncology, Medical University of Lublin, 20-093 Lublin, Poland; (P.K.)
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Žáčková D, Semerád L, Faber E, Klamová H, Stejskal L, Bělohlávková P, Karas M, Cmunt E, Černá O, Procházková J, Čičátková P, Kvetková A, Horňák T, Skoumalová I, Srbová D, Šálek C, Buffa D, Voglová J, Jurček T, Folta A, Ježíšková I, Žižková H, Machová Poláková K, Papajík T, Žák P, Jindra P, Svobodník A, Štěpánová R, Mayer J. Why are not all eligible chronic myeloid leukemia patients willing to attempt tyrosine kinase inhibitor discontinuation? A Czech nationwide analysis related to the TKI stopping trial HALF. Leukemia 2024; 38:893-897. [PMID: 38472478 PMCID: PMC10997522 DOI: 10.1038/s41375-024-02215-9] [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: 11/30/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/14/2024]
Affiliation(s)
- Daniela Žáčková
- Dpt. of Internal Medicine Hematology and Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic.
| | - Lukáš Semerád
- Dpt. of Internal Medicine Hematology and Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Edgar Faber
- Dpt. of Hemato-oncology, University Hospital Olomouc and Palacký University, Olomouc, Czech Republic
| | - Hana Klamová
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Lukáš Stejskal
- Dpt. of Hemato-oncology, University Hospital Ostrava and Ostrava University, Ostrava, Czech Republic
| | - Petra Bělohlávková
- 4th Dpt. of Internal Medicine and Hematology, University Hospital Hradec Králové and Charles University, Hradec Králové, Czech Republic
| | - Michal Karas
- Dpt. of Hemato-oncology, University Hospital Plzeň and Charles University, Plzeň, Czech Republic
| | - Eduard Cmunt
- 1st Dpt. of Internal Medicine - Hematology, General University Hospital, Prague, Czech Republic
| | - Olga Černá
- Dpt. Of Hematology, University Hospital Královské Vinohrady and Charles University, Prague, Czech Republic
| | - Jiřina Procházková
- Dpt. of Internal Medicine Hematology and Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Petra Čičátková
- Dpt. of Internal Medicine Hematology and Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Anežka Kvetková
- Dpt. of Internal Medicine Hematology and Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Tomáš Horňák
- Dpt. of Internal Medicine Hematology and Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Ivana Skoumalová
- Dpt. of Hemato-oncology, University Hospital Olomouc and Palacký University, Olomouc, Czech Republic
| | - Dana Srbová
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Cyril Šálek
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - David Buffa
- Dpt. of Hemato-oncology, University Hospital Ostrava and Ostrava University, Ostrava, Czech Republic
| | - Jaroslava Voglová
- 4th Dpt. of Internal Medicine and Hematology, University Hospital Hradec Králové and Charles University, Hradec Králové, Czech Republic
| | - Tomáš Jurček
- Dpt. of Internal Medicine Hematology and Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Adam Folta
- Dpt. of Internal Medicine Hematology and Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Ivana Ježíšková
- Dpt. of Internal Medicine Hematology and Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Hana Žižková
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | | | - Tomáš Papajík
- Dpt. of Hemato-oncology, University Hospital Olomouc and Palacký University, Olomouc, Czech Republic
| | - Pavel Žák
- 4th Dpt. of Internal Medicine and Hematology, University Hospital Hradec Králové and Charles University, Hradec Králové, Czech Republic
| | - Pavel Jindra
- Dpt. of Hemato-oncology, University Hospital Plzeň and Charles University, Plzeň, Czech Republic
| | - Adam Svobodník
- Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Radka Štěpánová
- Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiří Mayer
- Dpt. of Internal Medicine Hematology and Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic
- Central European Institute of Technology (CEITEC) Masaryk University, Brno, Czech Republic
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6
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Xu L, Wang Z, Wang G. Screening of Biomarkers Associated with Osteoarthritis Aging Genes and Immune Correlation Studies. Int J Gen Med 2024; 17:205-224. [PMID: 38268862 PMCID: PMC10807283 DOI: 10.2147/ijgm.s447035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/10/2024] [Indexed: 01/26/2024] Open
Abstract
Purpose Osteoarthritis (OA) is a joint disease with a long and slow course, which is one of the major causes of disability in middle and old-aged people. This study was dedicated to excavating the cellular senescence-associated biomarkers of OA. Methods The Gene Expression Omnibus (GEO) database was searched and five datasets pertaining to OA were obtained. After removing the batch effect, the GSE55235, GSE55457, GSE82107, and GSE12021 datasets were integrated together for screening of the candidate genes by differential analysis and weighted gene co-expression network analysis (WGCNA). Next, those genes were further filtered by machine learning algorithms to obtain cellular senescence-associated biomarkers of OA. Subsequently, enrichment analyses based on those biomarkers were conducted, and we profiled the infiltration levels of 22 types immune cells with the ERSORT algorithm. A lncRNA-miRNA-mRNA regulatory and drug-gene network were constructed. Finally, we validated the senescence-associated biomarkers at both in vivo and in vitro levels. Results Five genes (BCL6, MCL1, SLC16A7, PIM1, and EPHA3) were authenticated as cellular senescence-associated biomarkers in OA. ROC curves demonstrated the reliable capacity of the five genes as a whole to discriminate OA samples from normal samples. The nomogram diagnostic model based on 5 genes proved to be a reliable predictor of OA. Single-gene GSEA results pointed to the involvement of the five biomarkers in immune-related pathways and oxidative phosphorylation in the development of OA. Immune infiltration analysis manifested that the five genes were significantly correlated with differential immune cells. Subsequently, a lncRNA-miRNA-mRNA network and gene-drug network containing were generated based on five cellular senescence-associated biomarkers in OA. Conclusion A foundation for understanding the pathophysiology of OA and new insights into OA diagnosis and treatment were provided by the identification of five genes, namely BCL6, MCL1, SLC16A7, PIM1, and EPHA3, as biomarkers associated with cellular senescence in OA.
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Affiliation(s)
- Lanwei Xu
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People’s Republic of China
- Department of Hand and Foot Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, People’s Republic of China
| | - Zheng Wang
- Department of Neurosurgery, Liaocheng Traditional Chinese Medicine Hospital, Liaocheng, 252000, People’s Republic of China
| | - Gang Wang
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People’s Republic of China
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7
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Zhang Z, Zhou X, Zhou X, Cheng Z, Hu Y. Exploration of treatment-free remission in CML, based on molecular monitoring. Cancer Med 2024; 13:e6849. [PMID: 38133525 PMCID: PMC10807643 DOI: 10.1002/cam4.6849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/28/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Typical chronic myelogenous leukemia (CML) is a myeloproliferative neoplasm caused by t(9; 22)(q34; q11) translocation. This chromosomal translocation forms the BCR::ABL1 fusion gene. The tyrosine kinase encoded by the BCR::ABL1 is considered to be the main pathogenic diver. BCR::ABL1 is not only a therapeutic target, but also a monitoring target. Monitoring of BCR::ABL1 reveals the progression of the disease and guides the next treatment. Now for CML, the target of treatment has been focused on treatment-free remission (TFR). METHODS We conducted a literature review of current developments of treatment-free remission and molecular monitoring methods. RESULTS More effective and sensitive CML monitoring methods such as digital droplet PCR (ddPCR) and next generation sequencing (NGS) have further studied the measurable residual disease (MRD) and clonal heterogeneity, which provides strong support for the exploration of TFR. We discussed some of the factors that may be related to TFR outcomes at the molecular level, along with some monitoring strategies. CONCLUSION Currently, predictive indicators for treatment-free remission outcomes and recurrence are lacking in clinical practice. In future, treatment-free remission research should focus on combining the clinical indicators with molecular monitoring and biological markers to personalize patient conditions and guide clinicians to develop individualized treatment plans, so that more patients with CML can achieve safer and stabler treatment-free remission.
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MESH Headings
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Remission Induction
- Fusion Proteins, bcr-abl/genetics
- Neoplasm, Residual/genetics
- High-Throughput Nucleotide Sequencing
- Biomarkers, Tumor/genetics
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Affiliation(s)
| | | | - Xin Zhou
- Wuhan Union HospitalWuhanHubeiChina
| | | | - Yu Hu
- Wuhan Union HospitalWuhanHubeiChina
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8
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Yoshida C, Yamaguchi H, Doki N, Murai K, Iino M, Hatta Y, Onizuka M, Yokose N, Fujimaki K, Hagihara M, Oshikawa G, Murayama K, Kumagai T, Kimura S, Najima Y, Iriyama N, Tsutsumi I, Oba K, Kojima H, Sakamaki H, Inokuchi K. Importance of TKI treatment duration in treatment-free remission of chronic myeloid leukemia: results of the D-FREE study. Int J Hematol 2023; 117:694-705. [PMID: 36739328 PMCID: PMC10121524 DOI: 10.1007/s12185-023-03549-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/21/2023] [Accepted: 01/22/2023] [Indexed: 02/05/2023]
Abstract
Treatment-free remission (TFR) is a new goal for patients with chronic myeloid leukemia in chronic phase (CML-CP) with a sustained deep molecular response (DMR) to treatment with tyrosine kinase inhibitors (TKIs). However, optimal conditions for successful TFR in patients treated with second-generation (2G)-TKIs are not fully defined. In this D-FREE study, treatment discontinuation was attempted in newly diagnosed CML-CP patients treated with the 2G-TKI dasatinib who achieved BCR-ABL1 levels of ≤ 0.0032% (MR4.5) on the international scale (BCR-ABL1IS) and maintained these levels for exactly 1 year. Of the 173 patients who received dasatinib induction therapy for up to 2 years, 123 completed and 60 (48.8%) reached MR 4.5. Among the first 21 patients who maintained MR4.5 for 1 year and discontinued dasatinib, 17 experienced molecular relapse defined as loss of major molecular response (BCR-ABL1IS > 0.1%) confirmed once, or loss of MR4 (BCR-ABL1IS > 0.01%) confirmed on 2 consecutive assessments. The estimated molecular relapse-free survival rate was 16.7% at 12 months. This study was prematurely terminated according to the protocol's safety monitoring criteria. The conclusion was that sustained DMR for just 1 year is insufficient for TFR in CML-CP patients receiving dasatinib for less than a total of 3 years of treatment.
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Affiliation(s)
- Chikashi Yoshida
- Department of Hematology, National Hospital Organization Mito Medical Center, 280 Sakuranosato, Ibarakimachi, Higashiibarakigun, Ibaraki, 311-3193, Japan.
| | | | - Noriko Doki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Kazunori Murai
- Department of Hematology, Iwate Prefectural Central Hospital, Morioka, Japan
| | - Masaki Iino
- Department of Medical Oncology, Yamanashi Prefectural Central Hospital, Kofu, Japan
| | - Yoshihiro Hatta
- Division of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Makoto Onizuka
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan
| | - Norio Yokose
- Department of Hematology, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan
| | | | - Masao Hagihara
- Department of Hematology, EIJU General Hospital, Taito-Ku, Japan
| | - Gaku Oshikawa
- Japanese Red Cross Musashino Hospital, Musashino, Japan
| | - Kayoko Murayama
- Division of Hematology, Gunma Prefectural Cancer Center, Ohta, Japan
| | - Takashi Kumagai
- Department of Hematology, Ome Municipal General Hospital, Ome-Shi, Tokyo, Japan
| | - Shinya Kimura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Yuho Najima
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Noriyoshi Iriyama
- Division of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Ikuyo Tsutsumi
- Department of Hematology, National Hospital Organization Mito Medical Center, 280 Sakuranosato, Ibarakimachi, Higashiibarakigun, Ibaraki, 311-3193, Japan
| | - Koji Oba
- Department of Biostatistics, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Kojima
- Ibaraki Clinical Education and Training Center, University of Tsukuba Hospital, Kasama, Japan
| | - Hisashi Sakamaki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Koiti Inokuchi
- Department of Hematology, Nippon Medical School, Tokyo, Japan
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Chen Y, Zhao H, Guo J, Zou J, He W, Han D, Cheng F, Zhang Y, Li W. Successful treatment discontinuation in CML patients with full-dose and low-dose TKI: Results from real-world practice. Front Pharmacol 2023; 14:1101743. [PMID: 36755944 PMCID: PMC9899816 DOI: 10.3389/fphar.2023.1101743] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/09/2023] [Indexed: 01/24/2023] Open
Abstract
Background: In clinical studies, some patients who achieve deep molecular response (DMR) can successfully discontinue tyrosine kinase inhibitor (TKI). TKI dose reduction is also an important aspect of alleviating adverse effects and improving quality of life. This study aimed to explore the outcome after drug withdrawal in Chinese CML patients. Methods: We conducted a retrospective analysis of the outcome of 190 patients who stopped TKI. 27 patients experienced dose reduction before TKI discontinuation. The median duration of TKI treatment and MR4 before discontinuation was 82 months and 61 months. Results: With median follow-up after stopping TKI treatment of 17 months, the estimated TFR (Treatment Free Remission) were 76.9% (95%CI, 70.2%-82.4%), 68.8% (95%CI, 61.3%-75.2%), and 65.5% (95%CI, 57.4%-72.5%) at 6, 12 and 24 months. For full-dose and low-dose TKI groups, the TFR at 24 months was 66.7% and 55.8% (p = 0.320, log-rank). Most patients (56/57) quickly achieved MMR after restarting TKI treatment. Multivariable analysis showed that patients with TKI resistance had a higher risk of molecular relapse than patients without TKI resistance (p < 0.001). Conclusion: TFR rates were not impaired in patients experiencing dose reduction before TKI discontinuation compared to patients with full-dose TKI. Our data on Chinese population may provide a basis for the safety and feasibility of TKI discontinuation, including discontinuation after dose reduction, in clinical practice.
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Affiliation(s)
- Yilin Chen
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Huifang Zhao
- Department of Hematology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jingming Guo
- Department of Hematology, Yichang Central People’s Hospital & First Clinical Medical College of China Three Gorges University, Yichang, Hubei, China
| | - Jing Zou
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wenjuan He
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Danlei Han
- Department of Hematology, Yichang Central People’s Hospital & First Clinical Medical College of China Three Gorges University, Yichang, Hubei, China
| | - Fanjun Cheng
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China,*Correspondence: Yanli Zhang, ; Weiming Li, ; Fanjun Cheng,
| | - Yanli Zhang
- Department of Hematology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China,*Correspondence: Yanli Zhang, ; Weiming Li, ; Fanjun Cheng,
| | - Weiming Li
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China,*Correspondence: Yanli Zhang, ; Weiming Li, ; Fanjun Cheng,
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Canon A, Roy L, Chevalier X, Giraudier S, Eymard F. Calcific tendinopathy: an unexpected side effect of tyrosine kinase inhibitor? Leuk Lymphoma 2022; 63:3175-3180. [PMID: 36054826 DOI: 10.1080/10428194.2022.2118538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Musculoskeletal (MSK) pains have been reported during TKI treatment or after its discontinuation in patients with chronic myeloid leukemia (CML). We hypothesized that MSK pains originate from calcific tendinopathy according to preliminary clinical observations. We conducted a retrospective study including CML patients divided into three groups: patients with MSK pain during TKI treatment; asymptomatic patients during TKI treatment; patients with MSK pain after TKI discontinuation. Patients with MSK pain were clinically evaluated, and the presence of calcific deposits was assessed in X-rays of both shoulders and pelvis. Forty-five patients were included; 14 described MSK pain during TKI treatment and 12 after TKI discontinuation. A diagnosis of rotator cuff tendinopathy was retained for 57.7% of patients and of gluteus tendinopathy in 19.2%. The prevalence of calcifications in shoulders and/or hips was 64.3% in symptomatic patients receiving TKIs, 63.2% in asymptomatic patients and 75.0% in patients with MSK pain after TKI treatment.
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Affiliation(s)
- Alice Canon
- Department of Rheumatology, AP-HP, Henri Mondor Hospital, Créteil, France
| | - Lydia Roy
- Department of Hematology, AP-HP, Henri Mondor Hospital, Créteil, France
| | - Xavier Chevalier
- Department of Rheumatology, AP-HP, Henri Mondor Hospital, Créteil, France
| | | | - Florent Eymard
- Department of Rheumatology, AP-HP, Henri Mondor Hospital, Créteil, France
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11
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Zhao HF, Yang YF, Liu BC, Li WM, Xu N, Liu XL, Jiang Q, Dang HB, Liang LX, Zhang Y, Song YP. [Observational study of chronic myeloid leukemia Chinese patients who discontinued tyrosine kinase inhibitors in the real-world]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2022; 43:636-643. [PMID: 36709147 PMCID: PMC9593009 DOI: 10.3760/cma.j.issn.0253-2727.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Indexed: 01/30/2023]
Abstract
Objective: This study aimed to observe whether the treatment-free remission (TFR) of second-generation tyrosine kinase inhibitors (TKI) in chronic myeloid leukemia (CML) is better than imatinib (IM) . Methods: The clinical data of 274 CML patients who discontinued treatment and with complete clinical data were retrospectively studied from June 2013 to March 2021. Using both univariate and multivariate Cox proportional hazards regression models, risk factors influencing TFR outcomes after drug withdrawal in CML patients were assessed. Results: A total of 274 patients were enrolled, 140 patients were women (51.1%) , with a median age of 48 (9-84) years at the time of TKI discontinuation. Prior to TKI discontinuation, 172 (62.8%) patients were treated with IM, and 102 (37.2%) had received second-generation TKI treatment, including 73 patients who had shifted from IM to a second-generation TKI and 29 patients who used second-generation TKI as the first-line treatment. The rationale for converting to a second-generation TKI are as follows: 37 patients aimed deep molecular response (DMR) to achieve TFR, seven patients changed due to IM intolerance, and 29 patients changed because of failure to achieve the optimal treatment response. The use of the last type of TKI included 96 patients (94.1%) with nilotinib, three patients (2.9%) with dasatinib, and two patients (2%) with flumatinib, including one patient who changed to IM due to second-generation TKI intolerance. No statistical differences were found in the median age at diagnosis and TKI discontinuation, sex, Sokal score, IFN treatment before TKI, median time of TKI treatment to achieve DMR, and the reasons for TKI discontinuation between the second TKI and IM (P>0.05) .The median cumulative treatment time of TKI (71.5 months vs 88 months, P<0.001) , the last TKI median treatment time (60 months vs 88 months, P<0.001) , and the median duration of DMR (58 months vs 66 months, P=0.002) were significantly shorter in the second-generation TKI compared with IM. In the median follow-up of 22 (6-118) months after TKI discontinuation, 88 patients (32.1%) had lost their MMR at a median of 6 (1-91) months; of the 53 patients (60.2%) who lost MMR within 6 months, the overall TFR rate was 67.9%, and the cumulative TFR rates at 12 and 24 months were 70.5% and 67.5%, respectively. Withdrawal syndrome occurred in 26 patients (9.5%) . For patients who restarted TKI treatment, 72 patients (83.7%) achieved DMR again at a median treatment of 4 (1 to 18) months. The univariate analysis showed that the TFR rate of patients treated with second-generation TKI was significantly higher than those who were treated with IM (77.5% vs 62.2%, P=0.041) . A further subgroup analysis found that the TFR rate of the second-generation TKI patients was significantly higher than those treated with IM (80.8% vs 62.2%, P=0.026) . No significant difference was found in the second-generation TKI used as the first line treatment compared with those who were treated with IM (69.0% vs 62.2%, P=0.599) . The multivariate analysis results showed that second-generation TKI treatment was an independent prognostic factor affecting TFR in patients who discontinued TKI (RR=1.827, 95%CI 1.015-3.288, P=0.044) . Conclusion: In the clinical setting, more CML patients rapidly achieved TFR using second-generation TKI than IM treatment.
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Affiliation(s)
- H F Zhao
- Department of Hematology, Henan Cancer Hospital, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Y F Yang
- Department of Hematology, Institute of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - B C Liu
- Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - W M Li
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - N Xu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - X L Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Q Jiang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Blood System Diseases, Beijing 100044, China
| | - H B Dang
- The First Affiliated Hospital of Nanyang Medical College, Nanyang 473000, China
| | - L X Liang
- Department of Hematology, Sanmenxia Central Hospital, Sanmenxia 472000, China
| | - Yanli Zhang
- Department of Hematology, Henan Cancer Hospital, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Y P Song
- Department of Hematology, Henan Cancer Hospital, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
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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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Shima H, Kada A, Tanizawa A, Sato I, Tono C, Ito M, Yuza Y, Watanabe A, Kamibeppu K, Uryu H, Koh K, Imai C, Yoshida N, Koga Y, Fujita N, Saito AM, Adachi S, Ishii E, Shimada H. Discontinuation of tyrosine kinase inhibitors in pediatric chronic myeloid leukemia. Pediatr Blood Cancer 2022; 69:e29699. [PMID: 35403816 DOI: 10.1002/pbc.29699] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/20/2022] [Accepted: 03/15/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The feasibility of tyrosine kinase inhibitor (TKI) discontinuation in pediatric chronic myeloid leukemia (CML) remains to be fully elucidated. PROCEDURES TKI was prospectively discontinued in patients who were diagnosed with CML at <20 years of age, treated with TKI for ≥3 years, and sustained molecular response 4.0 (MR4.0) for ≥2 years. Molecular relapse was defined as a single loss of major molecular response (MMR) (BCR-ABL1IS >0.1%). Relapsed patients resumed the same TKI therapy administered before discontinuation. RESULTS Twenty-two patients with chronic-phase CML were enrolled, and the median ages at diagnosis and at TKI discontinuation were 9 (range: 1-14) years and 16 (5-26) years, respectively. The median follow-up time after TKI discontinuation was 37 months (range: 24-41 months). The median duration of TKI treatment before discontinuation was 100 (42-178) months, and that of MR4.0 was 53.5 (25-148) months. The treatment-free remission (TFR) rate at 12 months was 50.0% (90% confidence interval: 31.7%-65.8%). Eleven patients experienced loss of MMR within 4 months after TKI discontinuation and resumed TKI as originally prescribed. No progression was observed, and all 11 patients regained MR4.0 after TKI resumption. No patient had a withdrawal syndrome. The quality-of-life analysis suggested that successful TFR may improve academic performance in some patients. In patients who discontinued TKI therapy before puberty, the possibility of improvement in growth velocity upon TKI discontinuation was observed. CONCLUSIONS TKI could be discontinued safely in patients with pediatric CML showing a sustained deep MR.
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Affiliation(s)
- Haruko Shima
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Akiko Kada
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Aichi, Japan
| | | | - Iori Sato
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chikako Tono
- Department of Pediatrics, Iwate Prefectural Chubu Hospital, Iwate, Japan
| | - Masaki Ito
- Department of Pediatrics, Soma General Hospital, Fukushima, Japan
| | - Yuki Yuza
- Department of Hematology/Oncology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Akihiro Watanabe
- Department of Pediatrics, Niigata Cancer Center Hospital, Niigata, Japan
| | - Kiyoko Kamibeppu
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideko Uryu
- Department of Pediatrics, National Center for Global Health and Medicine, Tokyo, Japan
| | - Katsuyoshi Koh
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Chihaya Imai
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Nao Yoshida
- Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Aichi, Japan
| | - Yuhki Koga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Naoto Fujita
- Department of Pediatrics, Hiroshima Red Cross Hospital & Atomic-Bomb Survivors Hospital, Hiroshima, Japan
| | - Akiko M Saito
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Aichi, Japan
| | | | - Eiichi Ishii
- Department of Pediatrics, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Hiroyuki Shimada
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
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Inzoli E, Aroldi A, Piazza R, Gambacorti‐Passerini C. Tyrosine Kinase Inhibitor discontinuation in Chronic Myeloid Leukemia: eligibility criteria and predictors of success. Am J Hematol 2022; 97:1075-1085. [PMID: 35384030 PMCID: PMC9546318 DOI: 10.1002/ajh.26556] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 12/11/2022]
Abstract
TKI discontinuation proved to be safe and feasible in patients with CML with deep and durable molecular responses, introducing an additional treatment goal for these patients beyond overall survival. However, treatment interruption is a safe procedure only with appropriate patient selection and monitoring. Clinical and biological factors associated with better outcomes do not yet offer a precise stratification of patients according to their risk of relapse. This article aims at reviewing the leading studies present in the field in order to define eligibility criteria for discontinuation and predictors of success.
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Affiliation(s)
- Elena Inzoli
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanoItaly
- Hematology Division and Bone Marrow UnitSan Gerardo Hospital, ASST MonzaMonzaItaly
| | - Andrea Aroldi
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanoItaly
- Hematology Division and Bone Marrow UnitSan Gerardo Hospital, ASST MonzaMonzaItaly
| | - Rocco Piazza
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanoItaly
- Hematology Division and Bone Marrow UnitSan Gerardo Hospital, ASST MonzaMonzaItaly
| | - Carlo Gambacorti‐Passerini
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanoItaly
- Hematology Division and Bone Marrow UnitSan Gerardo Hospital, ASST MonzaMonzaItaly
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Boquimpani C, Seguro FS, Magalhães GHR, Pinto ILS, Bendit I, Bortolini JAP, Pagnano KBB, Centrone R, Funke V. Brazilian chronic myeloid leukemia working group recommendations for discontinuation of tyrosine kinase inhibitors in chronic myeloid leukemia in clinical practice. Hematol Transfus Cell Ther 2022; 44:402-409. [PMID: 35654721 PMCID: PMC9477780 DOI: 10.1016/j.htct.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/13/2022] [Accepted: 04/01/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction Treatment-free remission (TFR) is a new goal of chronic myeloid leukemia (CML) therapy. TFR is feasible when the patient has achieved a deep and stable molecular response and met the criteria required to ensure its success. Treatment discontinuation should not be proposed to the CML patient if minimum conditions are not met. In Brazil, for example, molecular tests (BCR::ABL1) are not broadly available, making it difficult to monitor the patients adequately. Objective In this sense, providing TFR recommendations for Brazilian physicians are therefore necessary. These recommendations include the main criteria checklist to start the TKIs treatment discontinuing process in patients diagnosed with CML and the population-eligible characteristics for treatment discontinuation. Method Age, risk score at diagnosis, TKI treatment duration, BCR::ABL1 transcripts type, depth of the molecular response for treatment discontinuation, treatment adherence, patient monitoring and withdrawal syndrome are essential factors to consider in TFR. After TKI discontinuation, BCR::ABL1 transcripts monitoring should be more frequent. When a major molecular response loss is observed during the monitoring of a patient in TFR, the TKI treatment should be resumed. Conclusion These recommendations should serve as a basis for medical professionals interested in proposing TKI discontinuation for CML patients in clinical practice. It is important to highlight that, despite the benefits of TFR for the patients and the health system, it should only be feasible following the minimum standards proposed in this recommendation.
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Chen YL, Zou J, Zhang YL, Li WM. [Dose optimization: an individualized treatment strategy for chronic myeloid leukemia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2022; 43:436-440. [PMID: 35680605 PMCID: PMC9250953 DOI: 10.3760/cma.j.issn.0253-2727.2022.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Y L Chen
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - J Zou
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Y L Zhang
- Department of Hematology, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - W M Li
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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17
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Treatment-free remission in patients with chronic myeloid leukemia: recommendations of the LALNET expert panel. Blood Adv 2021; 5:4855-4863. [PMID: 34438444 PMCID: PMC9153024 DOI: 10.1182/bloodadvances.2020003235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 03/22/2021] [Indexed: 01/26/2023] Open
Abstract
Discontinuing TKIs in LA is the new goal, and LALNET TFR recommendations for CML patients are an unmet need. TFR recommendations adapted to LA needs will make discontinuation feasible and safe in real life in the region.
Tyrosine kinase inhibitors (TKIs) have dramatically changed the survival of chronic myeloid leukemia (CML) patients, and treatment-free remission (TFR) has recently emerged as a new goal of CML treatment. The aim of this work was to develop recommendations for TKI discontinuation in Latin America (LA), outside of clinical trials. A working group of CML experts from LA discussed 22 questions regarding TFR and reached a consensus for TFR recommendations in the region. TFR is indicated in patients in first chronic phase, with typical BCR-ABL transcripts, under TKI treatment of a minimum of 5 years, in sustained deep molecular response (DMR; molecular response 4.5 [MR4.5]) for 2 years. Sustained DMR must be demonstrated on at least 4 international reporting scale quantitative polymerase chain reaction (PCR) tests, separated by at least 3 months, in the immediate prior 2 years. After second-line therapy, TFR is indicated in previously intolerant, not resistant, patients. Molecular monitoring is recommended monthly for the first 6 months, every 2 to 3 months from months 7 to 12, and every 3 months during the second year, indefinitely. Treatment should be reintroduced if major molecular response is lost. Monitoring of withdrawal syndrome, glucose levels, and lipid profile is recommended after discontinuation. After TKI reintroduction, molecular monitoring is indicated every 2 to 3 months until MR4.0 achievement; later, every 3 to 6 months. For the TFR attempt, having standardized and reliable BCR-ABL PCR tests is mandatory. These recommendations will be useful for safe discontinuation in daily practice and will benefit patients who wish to stop treatment in emergent regions, in particular, with TKI-related chronic adverse events.
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18
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Khouri C, Mahé J, Caquelin L, Locher C, Despas F. Pharmacology and pharmacovigilance of protein kinase inhibitors. Therapie 2021; 77:207-217. [PMID: 34895753 DOI: 10.1016/j.therap.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/31/2021] [Indexed: 11/19/2022]
Abstract
Protein kinase inhibitors experienced their advent in the 2000s. Their market introduction made it possible to constitute a class of targeted therapies administered orally. This name was chosen to mark a break with conventional chemotherapy drugs, but it is important to stress that these are multi-target drugs with complex affinity profiles. Adverse effects can be explained by direct interactions with their targets of interest, chosen for their indications (on-target) but also interactions with other targets (off-target). The adverse effect profiles of these drugs are therefore varied and it is possible to identify common profiles related to inhibitions of common targets. Identification of these targets has improved the global understanding of the pathophysiological mechanisms underlying the onset of adverse drug reactions as well as of the related diseases, and makes it possible to predict the adverse effect profile of new protein kinase inhibitors based on their affinities. In this review, we describe the main adverse drug reactions associated with protein kinase inhibitors, their frequency and their plausible mechanisms of action.
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Affiliation(s)
- Charles Khouri
- Pharmacovigilance Department, Grenoble Alpes University Hospital, 38000 Grenoble, France; Inserm UMR 1300-HP2 Laboratory, University Grenoble Alpes, 38000 Grenoble, France
| | - Julien Mahé
- Department of Pharmacology, Regional Pharmacovigilance Center, CHU de Nantes, 44093 Nantes, France
| | - Laura Caquelin
- Inserm, CIC 1414 (centre d'investigation clinique de Rennes), Université Rennes, CHU de Rennes, 35000 Rennes, France
| | - Clara Locher
- Inserm, CIC 1414 (centre d'investigation clinique de Rennes), Université Rennes, CHU de Rennes, 35000 Rennes, France
| | - Fabien Despas
- Inserm 1297, CIC 1436, Department of Medical and Clinical Pharmacology, Faculty of Medicine, CHU de Toulouse, University Paul-Sabatier, 31000 Toulouse, France.
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19
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How I Treat Chronic Phase Chronic Myelogenous Leukemia. Blood 2021; 139:3138-3147. [PMID: 34529784 DOI: 10.1182/blood.2021011722] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 08/23/2021] [Indexed: 11/20/2022] Open
Abstract
When imatinib, the first tyrosine kinase inhibitor (TKI) developed for use in chronic myelogenous leukemia (CML) was approved in 2001, the treatment of this disease was forever changed. Significant reductions in the molecular burden of disease were seen with the first generation TKI imatinib and with the addition of dasatinib (2006), nilotinib (2007), bosutinib (2012) and ponatinib (2013), deeper and more rapid reductions were noted. Physicians could begin to tailor TKI therapy to individual patients, and patients who did not respond to or could not tolerate first line therapy now had options. Importantly, the number of patients who developed accelerated or blast phase disease decreased dramatically. Research in CML continues to evolve and by presenting illustrative cases, this article will review some of the newer aspects of clinical care in this disease. Updated information regarding bosutinib and asciminib, the latter currently in clinical trials, will be presented; bosutinib is of particular interest as the drug's transit through the United States Food and Drug Administration (FDA) highlights the question of what is considered optimal response to TKI therapy. The challenge of understanding the cardiac safety data of ponatinib and the unique dosing schedule based on individual response will be discussed. Lastly, two cases will focus on features of TKI treatment that -remarkably- have become part of the treatment algorithm: family planning for women with CML and stopping therapy after meeting a specific treatment milestone.
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20
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Millot F, Suttorp M, Ragot S, Leverger G, Dalle JH, Thomas C, Cheikh N, Nelken B, Poirée M, Plat G, Versluys B, Lausen B, Borisevich M. Discontinuation of Imatinib in Children with Chronic Myeloid Leukemia: A Study from the International Registry of Childhood CML. Cancers (Basel) 2021; 13:4102. [PMID: 34439257 PMCID: PMC8392145 DOI: 10.3390/cancers13164102] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/06/2021] [Accepted: 08/10/2021] [Indexed: 11/16/2022] Open
Abstract
Within the International Registry of Childhood Chronic Myeloid Leukemia (CML), we identified 18 patients less than 18 years old at diagnosis of CML who were in the chronic phase and exhibiting a sustained deep molecular response (DMR) to imatinib defined as BCR-ABL1/ABL1 < 0.01% (MR4) for at least two years followed by discontinuation of imatinib. Before discontinuation, the median duration of imatinib was 73.2 months (range, 32-109) and the median duration of MR4 was 46.2 months (range, 23.9-98.6). Seven patients experienced loss of major molecular response (MMR) 4.1 months (range, 1.9-6.4) after stopping and so restarted imatinib. The median molecular follow-up after discontinuation was 51 months (range, 6-100) for the nine patients without molecular relapse. The molecular free remission rate was 61% (95% CI, 38-83%), 56% (95% CI, 33-79%) and 56% (95% CI, 33-79%) at 6, 12 and 36 months, respectively. Six of the seven children who experienced molecular relapse after discontinuation regained DMR (median, 4.7 months; range, 2.5-18) after restarting imatinib. No withdrawal syndrome was observed. In univariate analysis, age, sex, Sokal and ELTS scores, imatinib treatment and DMR durations before discontinuation had no influence on treatment free remission. These data suggest that imatinib can be safely discontinued in children with sustained MR4 for at least two years.
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Affiliation(s)
- Frédéric Millot
- Inserm CIC 1402, University Hospital of Poitiers, 86000 Poitiers, France;
| | - Meinolf Suttorp
- Medical Faculty, Pediatric Hemato-Oncology, Technical University Dresden, 01307 Dresden, Germany;
| | - Stéphanie Ragot
- Inserm CIC 1402, University Hospital of Poitiers, 86000 Poitiers, France;
| | - Guy Leverger
- Department of Pediatric Hematology, Trousseau Hospital, 75012 Paris, France;
| | - Jean-Hugues Dalle
- Department of Pediatric Hematology, Robert Debré University Hospital, 75019 Paris, France;
| | - Caroline Thomas
- Department of Pediatric Hematology, University Hospital of Nantes, 44000 Nantes, France;
| | - Nathalie Cheikh
- Department of Pediatric Hematology, University Hospital of Besançon, 25056 Besançon, France;
| | - Brigitte Nelken
- Department of Pediatric Hematology, University Hospital of Lille, 59000 Lille, France;
| | - Marilyne Poirée
- Department of Pediatric Hematology, University Hospital of Nice, 06000 Nice, France;
| | - Geneviève Plat
- Department of Pediatric Hematology, University Hospital of Toulouse, 31000 Toulouse, France;
| | - Birgitta Versluys
- Department of Hematology, University Medical Center Utrecht, 3584 Utrecht, The Netherlands;
| | - Birgitte Lausen
- Department of Pediatrics, Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Marina Borisevich
- Belarusian Research Centre for Pediatric Oncology, Hematology and Immunology, 223053 Minsk, Belarus;
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21
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Kwaśnik P, Giannopoulos K. Treatment-Free Remission-A New Aim in the Treatment of Chronic Myeloid Leukemia. J Pers Med 2021; 11:697. [PMID: 34442340 PMCID: PMC8399881 DOI: 10.3390/jpm11080697] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 02/08/2023] Open
Abstract
Tyrosine kinases inhibitors (TKIs) revolutionized chronic myeloid leukemia (CML) treatment for many years, prolonging patients' life expectancy to be comparable to age-matched healthy individuals. According to the latest the European LeukemiaNet (ELN) recommendations, CML treatment aims to achieve long-term remission without treatment (TFR), which is feasible in more than 40% of patients. Nearly all molecular relapses occur during the first 6 months after TKI withdrawal and do not progress to clinical relapse. The mechanisms that are responsible for CML relapses remain unexplained. It is suggested that maintaining TFR is not directly related to the total disposing of the gene transcript BCR-ABL1, but it might be a result of the restoration of the immune surveillance in CML. The importance of the involvement of immunocompetent cells in the period of TKI withdrawal is also emphasized by the presence of specific symptoms in some patients with "withdrawal syndrome". The goal of this review is to analyze data from studies regarding TFRs in order to characterize the elements of the immune system of patients that might prevent CML molecular relapse. The role of modern droplet digital polymerase chain reaction (ddPCR) and next-generation sequencing (NGS) in better identification of low levels of BCR-ABL1 transcripts was also taken into consideration for refining the eligibility criteria to stop TKI therapy.
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Affiliation(s)
- Paulina Kwaśnik
- Department of Experimental Hematooncology, Medical University of Lublin, 20-093 Lublin, Poland;
| | - Krzysztof Giannopoulos
- Department of Experimental Hematooncology, Medical University of Lublin, 20-093 Lublin, Poland;
- Department of Hematology, St John’s Cancer Center, 20-090 Lublin, Poland
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22
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Smith SM, Hijiya N, Sakamoto KM. Chronic Myelogenous Leukemia in Childhood. Curr Oncol Rep 2021; 23:40. [PMID: 33718985 DOI: 10.1007/s11912-021-01025-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Chronic myelogenous leukemia (CML) is rare in children, requiring extrapolation from treatment of adults. In this review, we explore similarities and differences between adult and pediatric CML with a focus on therapeutic advances and emerging clinical questions. RECENT FINDINGS Pediatric CML is effectively treated with long-term targeted therapy using tyrosine kinase inhibitors (TKIs). Newly diagnosed pediatric patients in chronic phase can now be treated with imatinib, dasatinib, or nilotinib without allogeneic hematopoietic stem cell transplantation. While treatment-free remission is possible in adults in chronic phase with optimal response to therapy, data are currently insufficient to support stopping TKI in pediatrics outside of a clinical trial. Knowledge gaps remain regarding long-term and late effects of TKIs in pediatric CML. Targeted therapy has markedly improved outcomes for pediatric CML, while raising a number of clinical questions, including the possibility of treatment-free remission and long-term health implications of prolonged TKI exposure at a young age.
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Affiliation(s)
- Stephanie M Smith
- Division of Hematology/Oncology, Department of Pediatrics, Stanford University School of Medicine, CCSR-1215C, 269 Campus Drive, Stanford, CA, USA
| | - Nobuko Hijiya
- Division of Pediatric Hematology, Oncology and Stem Cell Transplant, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Kathleen M Sakamoto
- Division of Hematology/Oncology, Department of Pediatrics, Stanford University School of Medicine, CCSR-1215C, 269 Campus Drive, Stanford, CA, USA.
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23
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Turkina AG, Petrova AN, Chelysheva EY, Shukhov OA, Tsyba ON, Golenkov AK, Vysotskaia LL, Bykova AV, Nemchenko IS, Gusarova GA, Pospelova OM, Gurianova MA, Martynkevich IS, Abdullaev AO, Sudarikov AB, Kulikov SM, Savchenko VG. A prospective study of the monitoring of patients with chronic myeloid leukemia upon withdrawal of tyrosine kinase inhibitor therapy. RUSSIAN JOURNAL OF HEMATOLOGY AND TRANSFUSIOLOGY 2020. [DOI: 10.35754/0234-5730-2020-65-4-370-385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Introduction. The advent of tyrosine kinase inhibitors (TKIs) in clinical practice drastically improved prognosis in patients with chronic myeloid leukaemia (CML). Adverse events of the TKI therapy and its high financial burden warrant the trend to gradually abandon this treatment.Aim. To assess the results of CML patient monitoring after the withdrawal of TKI therapy.Patients and methods. This prospective study included 98 chronic phase CML patients satisfying the criteria: any receiving of TKI therapy for ≥3 years; deep molecular response (DMR, BCR-ABL ≤ 0.01 % IS) during ≥ 2 years. The withdrawal was followed by quantitative BCR-ABL estimation performed monthly for the first 6 months of the survey, bimonthly for 1 year and every 3 months from the second year onwards. Therapy was resumed at a loss of major molecular response (MMR, BCR-ABL ≥ 0.1 % IS).Results. The MMR loss upon the TKI withdrawal was observed in 48 (49 %) patients. Survival without MMR loss was 52 % past 24 months since withdrawal, with a median of 35 months (23–52). The duration of therapy, MR and the MR depth at the time of withdrawal significantly correlated with a conserved post-therapy MMR. Gender, age, a Sokal risk group, type and line of TKI therapy at withdrawal, and imatinib resistance in history were not observed to significantly impact molecular relapse-free remission. MMR was recovered in all 48 patients with TKI therapy resumed in molecular relapse. In 65 % of the patients, adverse therapy events observed during treatment completely resolved by 6 months of post-therapy monitoring. Musculoskeletal pain (withdrawal syndrome, WS) was reported in 42 % patients in the post-therapeutic period, which did not lead to TKI resumption. The WS development correlated with an elder age and longer therapy prior to withdrawal.Conclusion. Molecular relapse-free survival in CML patients with treatment-free remission (TFR) is comparable to other published evidence. Monitoring safety during TFR is attested by the lack of disease progression and MMR recovery upon TKI resumption in all patients.
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Affiliation(s)
| | | | | | | | | | - A. K. Golenkov
- Vladimirsky Moscow Regional Research and Clinical Institute
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24
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Rea D. Handling challenging questions in the management of chronic myeloid leukemia: when is it safe to stop tyrosine kinase inhibitors? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2020; 2020:243-247. [PMID: 33275744 PMCID: PMC7727570 DOI: 10.1182/hematology.2020002538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The paradigm for managing patients with chronic myeloid leukemia is evolving. In the recent past, restoring a normal life expectancy while patients are receiving never-ending targeted therapy with BCR-ABL1 tyrosine kinase inhibitors through prevention of progression to blast phase and mitigation of iatrogenic risks was considered the best achievable outcome. Now, long-term treatment-free remission with continued response off tyrosine kinase inhibitor therapy is recognized as the most optimal benefit of treatment. Indeed, numerous independent clinical trials provided solid proof that tyrosine kinase inhibitor discontinuation was feasible in patients with deep and sustained molecular responses. This article discusses when tyrosine kinase inhibitors may be safely stopped in clinical practice on the basis of the best and latest available evidence.
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Affiliation(s)
- Delphine Rea
- Département Médico-Universitaire d'Hématologie, Paris, France; and France Intergroupe des Leucémies Myéloïdes Chroniques, Lyon, France
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25
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Breccia M, Efficace F, Colafigli G, Scalzulli E, Di Prima A, Martelli M, Foà R. Tyrosine kinase inhibitor discontinuation in the management of chronic myeloid leukemia: a critical review of the current practice. Expert Rev Hematol 2020; 13:1311-1318. [DOI: 10.1080/17474086.2021.1852924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Massimo Breccia
- Hematology, Department of Translational and Precision Medicine, Azienda Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Gioia Colafigli
- Hematology, Department of Translational and Precision Medicine, Azienda Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Emilia Scalzulli
- Hematology, Department of Translational and Precision Medicine, Azienda Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Alessio Di Prima
- Hematology, Department of Translational and Precision Medicine, Azienda Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Maurizio Martelli
- Hematology, Department of Translational and Precision Medicine, Azienda Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Azienda Policlinico Umberto I, Sapienza University, Rome, Italy
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26
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Atallah E, Schiffer CA. Discontinuation of tyrosine kinase inhibitors in chronic myeloid leukemia: when and for whom? Haematologica 2020; 105:2738-2745. [PMID: 33054106 PMCID: PMC7716356 DOI: 10.3324/haematol.2019.242891] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/17/2020] [Indexed: 11/09/2022] Open
Abstract
Treatment discontinuation is considered one of the main goals of therapy for patients with chronic myeloid leukemia. Several criteria are felt to be necessary to consider discontinuation, while others may predict a better chance of achieving treatment-free remission. Criteria for discontinuation include patients in chronic phase chronic myeloid leukemia, a minimum duration of tyrosine kinase inhibitor therapy of 3 years, sustained deep molecular response for at least 2 years and a molecular response of at least MR4. In addition, proper education of the patient on the need for more frequent monitoring, possible side effects related to stopping and having a reliable real-time quantitative polymerase chain reaction laboratory are paramount to the safety and success of treatment-free remission. Realistically though, a maximum of only 20-30% of newly diagnosed patients will be able to achieve a successful treatment-free remission. In this article we will review for whom and when a trial of discontinuation should be considered.
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Affiliation(s)
| | - Charles A Schiffer
- Karmanos Cancer Institute, Wayne State University School of Medicine, Milwaukee, WI.
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27
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Handling challenging questions in the management of chronic myeloid leukemia: when is it safe to stop tyrosine kinase inhibitors? Blood Adv 2020; 4:5589-5594. [PMID: 33170936 DOI: 10.1182/bloodadvances.2020002538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/22/2020] [Indexed: 11/20/2022] Open
Abstract
The paradigm for managing patients with chronic myeloid leukemia is evolving. In the recent past, restoring a normal life expectancy while patients are receiving never-ending targeted therapy with BCR-ABL1 tyrosine kinase inhibitors through prevention of progression to blast phase and mitigation of iatrogenic risks was considered the best achievable outcome. Now, long-term treatment-free remission with continued response off tyrosine kinase inhibitor therapy is recognized as the most optimal benefit of treatment. Indeed, numerous independent clinical trials provided solid proof that tyrosine kinase inhibitor discontinuation was feasible in patients with deep and sustained molecular responses. This article discusses when tyrosine kinase inhibitors may be safely stopped in clinical practice on the basis of the best and latest available evidence.
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28
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Molica M, Noguera NI, Trawinska MM, Martinelli G, Cerchione C, Abruzzese E. Treatment free remission in chronic myeloid leukemia: Lights and shadows. Hematol Rep 2020; 12:8950. [PMID: 33042501 PMCID: PMC7520857 DOI: 10.4081/hr.2020.8950] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Indexed: 01/03/2023] Open
Abstract
In addition to the best possible overall survival, discontinuation of the tyrosine kinase-inhibitor (TKI) treatment [treatment free remission (TFR)] without observing a recurrence of the disease has become a standard part of chronic myeloid leukemia (CML) care. Worldwide, more than 2000 patients with CML have attempted TFR, and very rare instances of disease transformation have been reported. Several studies in the last decade have demonstrated the feasibility and safety of TKI discontinuation in selected patients with CML who achieve deep and sustained molecular response with TKI. This has moved prime-time into clinical practice although open questions remain in terms of understanding the disease biology that leads to successful TKI cessation in some patients while not in others. Despite the remaining questions regarding which factors may be considered predictive for TFR, treatment interruption is a safe option provided that adequate molecular monitoring is available, with prompt re-initiation of TKIs as soon as major molecular response has been lost. Data from ongoing trials should help refine decisions as to which patients are the best candidates to attempt TKI discontinuation, frequency of a safe monitoring, optimal strategies to sustain ongoing TFR and increase the number of patients who can access to discontinuation programs.
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Affiliation(s)
| | - Nelida I Noguera
- Department of Biomedicine and Prevention, Tor Vergata University of Rome
| | | | - Giovanni Martinelli
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
| | - Claudio Cerchione
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
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29
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Ureshino H, Kamachi K, Kimura S. Surrogate Markers for Treatment-Free Remission in Patients With Chronic Myeloid Leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:785-790. [PMID: 32768385 DOI: 10.1016/j.clml.2020.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 11/27/2022]
Abstract
BCR-ABL1 tyrosine kinase inhibitors (TKIs) improve long-term survival of patients with chronic-phase (CP) chronic myeloid leukemia (CML). Recently, the treatment goal for patients with CML-CP became safe discontinuation of TKIs. Several clinical trials have shown that approximately half of patients who experience a durable deep molecular response during TKI treatment maintain molecular remission after discontinuation of TKIs. However, the factors responsible for successful treatment-free remission (TFR) remain unclear. This study reviews very recent TKI discontinuation studies, focusing on factors responsible for TFR in patients with CML-CP. Longer TKI treatment duration, time of deep molecular response, presence of withdrawal syndrome, deeper molecular response, lower Sokal score, interferon α treatment before TKI administration, and favorable natural killer or T-cell profiles may be associated with TFR. However, different study designs have generated inconsistent data. Further investigations are needed to identify factors that consistently favor achievement of TFR.
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Affiliation(s)
- Hiroshi Ureshino
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan; Department of Drug Discovery and Biomedical Sciences, Faculty of Medicine, Saga University, Saga, Japan.
| | - Kazuharu Kamachi
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan; Department of Drug Discovery and Biomedical Sciences, Faculty of Medicine, Saga University, Saga, Japan
| | - Shinya Kimura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan; Department of Drug Discovery and Biomedical Sciences, Faculty of Medicine, Saga University, Saga, Japan
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30
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Annunziata M, Bonifacio M, Breccia M, Castagnetti F, Gozzini A, Iurlo A, Pregno P, Stagno F, Specchia G. Current Strategies and Future Directions to Achieve Deep Molecular Response and Treatment-Free Remission in Chronic Myeloid Leukemia. Front Oncol 2020; 10:883. [PMID: 32582549 PMCID: PMC7280484 DOI: 10.3389/fonc.2020.00883] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 05/05/2020] [Indexed: 12/21/2022] Open
Abstract
The treatment of chronic myeloid leukemia (CML) has been radically changed by the approval of tyrosine kinase inhibitors (TKIs), which target BCR-ABL1 kinase activity. CML is now managed as a chronic disease requiring long-term treatment and close molecular monitoring. It has been shown 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 many CML patients. However, only nilotinib has approval in this setting and a number of controversial aspects remain regarding treatment choices and timings, predictive factors, patient communication, and optimal strategies to achieve successful TFR. This narrative review aims to provide a comprehensive overview on how to optimize the path to DMR and TFR in patients with CML, and discusses recent data and future directions.
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Affiliation(s)
| | | | - Massimo Breccia
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Fausto Castagnetti
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology “L. and A. Seràgnoli”, “S. Orsola-Malpighi” Univeristy Hospital, University of Bologna, Bologna, Italy
| | - Antonella Gozzini
- Department of Cellular Therapy and Transfusional Medicine, AUO Careggi, Florence, Italy
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Patrizia Pregno
- Hematology Division, Oncology and Hematology Department, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Fabio Stagno
- Division of Hematology and Bone Marrow Transplant, AOU Policlinico—V. Emanuele, Catania, Italy
| | - Giorgina Specchia
- Hematology Section, Department of Emergency and Organ Transplantation, University of Bari-Aldo Moro, Bari, Italy
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31
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Treatment-free remission in patients with chronic myeloid leukaemia. Nat Rev Clin Oncol 2020; 17:493-503. [PMID: 32377005 DOI: 10.1038/s41571-020-0367-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2020] [Indexed: 01/08/2023]
Abstract
In the past few years, international treatment guidelines for chronic myeloid leukaemia have incorporated recommendations for attempting discontinuation of treatment with tyrosine-kinase inhibitors (TKIs) outside of the setting of a clinical trial with the aim of a treatment-free remission (TFR). Physicians involved in the treatment of chronic myeloid leukaemia need to be sufficiently well informed to guide patients through decision-making about the discontinuation of treatment with TKIs targeting BCR-ABL1 by providing a balanced assessment of the potential risks and benefits of stopping or continuing therapy. These guidelines also seek to ensure that the risks associated with being off treatment are kept to a minimum. In this Review, we summarize the clinical studies of TFR and how their results can guide routine clinical practice with a focus on specific aspects such as molecular monitoring and the pregnancy-specific risks associated with a TFR attempt in female patients. We also address the development of predictors of outcome after TKI discontinuation and present strategies that warrant further consideration to enable more patients to enter TFR.
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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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Clark RE. Tyrosine Kinase Inhibitor Therapy Discontinuation for Patients with Chronic Myeloid Leukaemia in Clinical Practice. Curr Hematol Malig Rep 2019; 14:507-514. [PMID: 31701369 PMCID: PMC6934633 DOI: 10.1007/s11899-019-00548-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE In chronic myeloid leukaemia, tyrosine kinase inhibitor treatment is traditionally given continuously for life. However, these drugs produce excellent responses for many patients, and this is accompanied by survival that is close to normal. This has prompted studies of whether it is possible to stop treatment, thus achieving a treatment-free remission (TFR). RECENT FINDINGS Most TFR studies have focussed on abrupt cessation in patients with long-standing deep remissions, but recent data suggest that more gradual treatment de-escalation may improve TFR success, and that it may be possible to extend TFR attempts to patients who are in stable major molecular response but not necessarily MR4. Further data are badly needed on TFR for patients whose remission is less than stable MR4 and on the importance of prior interferon-alpha treatment. Funding TFR trials in a disease with such an excellent outlook is an increasing challenge.
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MESH Headings
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- Biomarkers, Tumor
- Clinical Decision-Making
- Disease Management
- Drug Resistance, Neoplasm
- Fusion Proteins, bcr-abl/antagonists & inhibitors
- Fusion Proteins, bcr-abl/genetics
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/etiology
- Molecular Targeted Therapy
- Practice Patterns, Physicians'
- Protein Kinase Inhibitors/administration & dosage
- Protein Kinase Inhibitors/adverse effects
- Protein Kinase Inhibitors/therapeutic use
- Recurrence
- Remission Induction
- Treatment Outcome
- Withholding Treatment
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Affiliation(s)
- Richard E Clark
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Room 150, First floor, Sherrington Building, Ashton Street, Liverpool,, L69 3GE, UK.
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