International Journal of Clinical Oncology

, Volume 23, Issue 5, pp 974–979 | Cite as

Anxiety and depression associated with tyrosine kinase inhibitor discontinuation in patients with chronic myeloid leukemia

  • Rintaro Sogawa
  • Sakiko Kimura
  • Ryota Yakabe
  • Yasuhito Mizokami
  • Masanobu Tasaki
  • Naoko Sueoka-Aragane
  • Yutaka Narisawa
  • Shinya Kimura
Original Article



ABL tyrosine kinase inhibitors (TKIs) significantly changed the prognosis of patients with chronic myeloid leukemia (CML), and clinical trials demonstrated that TKIs can be discontinued in approximately 50% of patients after a period of deep molecular response (DMR). However, in some patients, TKI discontinuation leads to anxiety and depression. Here, we analysed the incidence of anxiety and depression in patients who stop TKI therapy.


Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale (HADS) in 32 patients with CML. The survey periods were at TKI discontinuation, at 1, 6, 12, and 24 months and at reintroduction of TKIs. The HADS score at the initial TKI discontinuation was compared between patients within and outside clinical trials. Treatment-free remission (TFR) rates outside clinical trials were evaluated.


The HADS scores were significantly higher at TKI reintroduction after molecular relapse than at the initial TKI discontinuation (at the initiation of stopping TKIs vs. at reintroduction of TKIs, 8.47 ± 5.53 vs. 1.67 ± 2.26; p = 0.0003). The TFR rate at 12 months after stopping TKIs outside clinical trials was 55.6%. The HADS score at the initial TKI discontinuation did not differ between patients within and outside clinical trials.


Stopping TKIs outside clinical trials is feasible if the guidelines for stopping are followed and an adequate monitoring system is available. Discontinuation of TKIs requires adequate management of anxiety and depression.


Chronic myeloid leukemia The Hospital Anxiety and Depression Scale Discontinuation of treatment ABL tyrosine kinase inhibitor 


Compliance with ethical standards

Conflict of interest

SK received research funding from Bristol-Myers Squibb, Pfizer, Otsuka Pharmaceutical, Novartis and Ohara Pharmaceutical, and received honoraria from Bristol-Myers Squibb, Pfizer, Otsuka Pharmaceutical and Novartis.


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Copyright information

© Japan Society of Clinical Oncology 2018

Authors and Affiliations

  • Rintaro Sogawa
    • 1
  • Sakiko Kimura
    • 1
  • Ryota Yakabe
    • 1
  • Yasuhito Mizokami
    • 1
  • Masanobu Tasaki
    • 1
  • Naoko Sueoka-Aragane
    • 1
    • 2
  • Yutaka Narisawa
    • 1
  • Shinya Kimura
    • 2
  1. 1.Department of PharmacySaga University HospitalSagaJapan
  2. 2.Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of MedicineSaga UniversitySagaJapan

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