TREATMENT-FREE REMISSION IN PATIENTS WITH CHRONIC MYELOID LEUKEMIA: MANAGEMENT APPROACHES

Abstract

Objective: The study objective was to analyze the short- and long-term results of treatment discontinuation in patients with chronic myeloid leukemia (CML) and complete molecular response (CMR). Methodology: This prospective study enrolled 22 patients (pts) with chronic phase of CML, managed at the Oncologic Institute from Moldova between 2017–2022. The age range was 29–73 years. The male/female ratio was 1:1.2. The real-time quantitative PCR revealed the wide range of BCR-ABL p210 transcript: 21.84–100% IS. In 7 (31.8%) pts the rate of BCR-ABL p210-positive cells was less than 50%. CMR was achieved in 15 (68.2%) pts after imatinib therapy and in 7 (31.8%) pts after the 2nd generation of TKIs. Results: The therapy with TKIs was stopped due to the different reasons in all patients after the CMR was obtained. Two (9.1%) pts stopped the TKIs treatment due to the pregnancy. The molecular relapse occurred in 6 (27.3%) pts, including one pregnant female. All relapsed pts had the initial BCR-ABL p210 transcript expression > 50%. The CMR span ranged between 2.5-26 months in relapsed pts. The range of BCR-ABL p210 transcript in the relapsed pts was 0.002-0.56%. These pts achieved the 2nd CMR after restarting TKIs treatment. All pts are alive, with the ECOG score of 0-1. Conclusion: TKIs discontinuation may be considered an option in CML patients with CMR, especially in those with the initially low BCR-ABL p210 transcript expression. The 2nd CMR may be obtained after restarting the TKIs treatment in pts with minor molecular relapse.