International Journal of Hematology

, Volume 110, Issue 6, pp 683–689 | Cite as

Effect of study-level factors on treatment-free remission rate in patients with chronic myeloid leukemia: a systematic review and meta-analysis

  • Jinchul Kim
  • Jisun Park
  • Yeonsook Moon
  • Suk Jin Choi
  • Joo Han Lim
  • Moon Hee Lee
  • Jinhyun ChoEmail author
Original Article


As it is recommended that most assessments for treatment-free remission (TFR) in patients with chronic myeloid leukemia be conducted as prospective trials, we conducted a systematic review and meta-analysis to investigate which study-level factors affected the TFR rate. The MEDLINE, Embase, and Cochrane databases were systematically searched from inception to July 2018. A random effect model was used to estimate the overall mean TFR rate, subgroup differences, and regression coefficients with continuous variables. Overall, 12 tyrosine kinase inhibitor (TKI) stopping studies comprising 1699 chronic myeloid leukemia patients were included in this analysis. The overall mean TFR rate at 24 months after entering TFR phase was 55% [95% confidence interval (CI) 0.51–0.58]. Trials with molecular criteria of MR4.5 or better for stopping TKI reported higher TFR rates than those of MR4.0 (57.2% vs. 50.5%). Trials with eligible criteria for at least 24 months of deep molecular response (DMR) duration demonstrated higher TFR rates than those for 18 or 12 months (60.2% vs. 49.9%). Our results suggest that TKI stopping trials with sufficient duration of DMR and molecular criteria of MR4.5 or better may account for approximately 60% of the TFR rate at 24 months after stopping TKI.


Meta-analysis Chronic myeloid leukemia Treatment-free remission Study-level factor 



This work was supported by INHA UNIVERSITY Research Grant. (no grant number)

Author contribution

All authors had full access to all the study data and take responsibility for the integrity of the data and accuracy of the data analysis. Study concept and design: J.K. and J.C. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: J.K., J.P., and J.C. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: J.K. and J.H.L. Study supervision: Y.M., S.J.C., M.H.L., and J.C.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Supplementary material

12185_2019_2744_MOESM1_ESM.pdf (479 kb)
Supplementary material 1 (PDF 479 kb)


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Copyright information

© Japanese Society of Hematology 2019

Authors and Affiliations

  1. 1.Department of Hematology-OncologyInha University College of Medicine and HospitalIncheonRepublic of Korea
  2. 2.Department of Laboratory MedicineInha University College of Medicine and HospitalIncheonRepublic of Korea
  3. 3.Department of PathologyInha University College of Medicine and HospitalIncheonRepublic of Korea

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