Results of following up patients with chronic myeloid leukemia and a deep molecular response without tyrosine kinase inhibitor therapy


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Abstract

Aim. To assess the results of following up patients with chronic myeloid leukemia (CML) and a deep molecular response (MR) without tyrosine kinase inhibitor (TKI) therapy. Subjects and methods. The reasons for TKI discontinuation in 70 patients with CML and a deep MR of more than 1 year’s duration were adverse events, pregnancy, and patients’ decision. Information was collected retrospectively and prospectively in 2008-2016. Results. The median follow-up after TKI therapy discontinuation was 23 months (2 to 100 months). At 6, 12 and 24 months after TKI therapy discontinuation, the cumulative incidence of major MR (MMR) loss was 28, 41 and 48%, respectively; the survival rates without TKI therapy were 69, 50, and 39%, respectively. MMR loss was noted in 28 (88%) patients at 12 months; it was not seen without TKI therapy at 2-year follow-up. Deaths due to CML progression were absent. The Sokal risk group was a reliable factor influencing MMR loss (p ≤ 0.05). The cumulative recovery rate for deep MR after resumption of TKI use was 73 and 100% at 12 and 24 months, respectively, with a median follow-up of 24 months (1 to 116 months). Deep MR recovered at a later time when the therapy was resumed more than 30 days after MMR loss. Conclusion. Safe follow-up is possible in about 50% of the patients with CML and stable deep MRs without TKI therapy. The introduction of this approach into clinical practice requires regular molecular genetic monitoring and organizational activities. Biological factors in maintaining remission after TKI discontinuation need to be separately studied.

About the authors

A G Turkina

ФГБУ «Национальный медицинский исследовательский центр гематологии» Минздрава России

Москва, Россия

E Yu Chelysheva

ФГБУ «Национальный медицинский исследовательский центр гематологии» Минздрава России

Москва, Россия

V A Shuvaev

ФГБУ «Российский научно-исследовательский институт гематологии и трансфузиологии» ФМБА

Санкт-Петербург, Россия

G A Gusarova

ФГБУ «Национальный медицинский исследовательский центр гематологии» Минздрава России

Москва, Россия

A V Bykova

ФГБУ «Национальный медицинский исследовательский центр гематологии» Минздрава России

Москва, Россия

O A Shukhov

ФГБУ «Национальный медицинский исследовательский центр гематологии» Минздрава России

Москва, Россия

A N Petrova

ФГБУ «Национальный медицинский исследовательский центр гематологии» Минздрава России

Москва, Россия

M V Vakhrusheva

ФГБУ «Национальный медицинский исследовательский центр гематологии» Минздрава России

Москва, Россия

S R Goryacheva

ФГБУ «Национальный медицинский исследовательский центр гематологии» Минздрава России

Москва, Россия

L Yu Kolosova

ФГБУ «Национальный медицинский исследовательский центр гематологии» Минздрава России

Москва, Россия

P S Krasikova

ГБУЗ «Оренбургская областная клиническая больница»

Оренбург, Россия

M S Fominykh

ФГБУ «Российский научно-исследовательский институт гематологии и трансфузиологии» ФМБА

Санкт-Петербург, Россия

I S Martynkevich

ФГБУ «Российский научно-исследовательский институт гематологии и трансфузиологии» ФМБА

Санкт-Петербург, Россия

A O Abdullaev

ФГБУ «Национальный медицинский исследовательский центр гематологии» Минздрава России

Москва, Россия

A B Sudarikov

ФГБУ «Национальный медицинский исследовательский центр гематологии» Минздрава России

Москва, Россия

V G Savchenko

ФГБУ «Национальный медицинский исследовательский центр гематологии» Минздрава России

Москва, Россия

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