Blood Advances (Dec 2019)

Managing chronic myeloid leukemia for treatment-free remission: a proposal from the GIMEMA CML WP

  • Michele Baccarani,
  • Elisabetta Abruzzese,
  • Vincenzo Accurso,
  • Francesco Albano,
  • Mario Annunziata,
  • Sara Barulli,
  • Germana Beltrami,
  • Micaela Bergamaschi,
  • Gianni Binotto,
  • Monica Bocchia,
  • Giovanni Caocci,
  • Isabella Capodanno,
  • Francesco Cavazzini,
  • Michele Cedrone,
  • Marco Cerrano,
  • Monica Crugnola,
  • Mariella D'Adda,
  • Chiara Elena,
  • Carmen Fava,
  • Paola Fazi,
  • Claudio Fozza,
  • Sara Galimberti,
  • Valentina Giai,
  • Antonella Gozzini,
  • Gabriele Gugliotta,
  • Alessandra Iurlo,
  • Gaetano La Barba,
  • Luciano Levato,
  • Alessandro Lucchesi,
  • Luigia Luciano,
  • Francesca Lunghi,
  • Monia Lunghi,
  • Michele Malagola,
  • Roberto Marasca,
  • Bruno Martino,
  • Angela Melpignano,
  • Maria Cristina Miggiano,
  • Enrico Montefusco,
  • Caterina Musolino,
  • Fausto Palmieri,
  • Patrizia Pregno,
  • Davide Rapezzi,
  • Giovanna Rege-Cambrin,
  • Serena Rupoli,
  • Marzia Salvucci,
  • Rosaria Sancetta,
  • Simona Sica,
  • Raffaele Spadano,
  • Fabio Stagno,
  • Mario Tiribelli,
  • Simona Tomassetti,
  • Elena Trabacchi,
  • Massimiliano Bonifacio,
  • Massimo Breccia,
  • Fausto Castagnetti,
  • Fabrizio Pane,
  • Domenico Russo,
  • Giuseppe Saglio,
  • Simona Soverini,
  • Paolo Vigneri,
  • Gianantonio Rosti

Journal volume & issue
Vol. 3, no. 24
pp. 4280 – 4290

Abstract

Read online

Abstract: Several papers authored by international experts have proposed recommendations on the management of BCR-ABL1+ chronic myeloid leukemia (CML). Following these recommendations, survival of CML patients has become very close to normal. The next, ambitious, step is to bring as many patients as possible into a condition of treatment-free remission (TFR). The Gruppo Italiano Malattie EMatologiche dell'Adulto (GIMEMA; Italian Group for Hematologic Diseases of the Adult) CML Working Party (WP) has developed a project aimed at selecting the treatment policies that may increase the probability of TFR, taking into account 4 variables: the need for TFR, the tyrosine kinase inhibitors (TKIs), the characteristics of leukemia, and the patient. A Delphi-like method was used to reach a consensus among the representatives of 50 centers of the CML WP. A consensus was reached on the assessment of disease risk (EUTOS Long Term Survival [ELTS] score), on the definition of the most appropriate age boundaries for the choice of first-line treatment, on the choice of the TKI for first-line treatment, and on the definition of the responses that do not require a change of the TKI (BCR-ABL1 ≤10% at 3 months, ≤1% at 6 months, ≤0.1% at 12 months, ≤0.01% at 24 months), and of the responses that require a change of the TKI, when the goal is TFR (BCR-ABL1 >10% at 3 and 6 months, >1% at 12 months, and >0.1% at 24 months). These suggestions may help optimize the treatment strategy for TFR.