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Real World Outcomes with Treatment Free Remission in Chronic Myeloid Leukemia-Experience from a Tertiary Care Cancer Centre

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Abstract

Chronic myeloid leukaemia (CML) is caused by balanced translocation t(9::22)(q34;q11) resulting in formation of pathogenic BCR-ABL fusion gene. Tyrosine kinase inhibitors (TKI) have revolutionised the treatment of CML. Ongoing treatment with TKI leads to side effects and has financial impact. Teratogenic potential of TKI and growth disturbance also represent an important challenge. Thus, TKI discontinuation in form of treatment free remission (TFR) has emerged as a new and important therapeutic goal. In this retrospective study, we reviewed CML patients who were kept on TFR. Inclusion criteria was patient age ≥ 18 years diagnosed with CML in chronic phase who met the criteria for TFR and opted for same and who were in DMR but stopped TKI for any reason. We analysed the data for baseline characteristics, molecular relapse (MR), survival without molecular relapse (SWMR), TFR duration and factors affecting MR. We included 38 patients in this analysis. Thirty five (92%) patients were treated with imatinib at diagnosis. Median duration of TKI treatment was 135 months. 37 patients (97.5%) achieved DMR on TKI and median time from TKI initiation to DMR was 96 months. Median duration of DMR prior to TKI discontinuation was 41 months. TKI was discontinued after counselling for TFR in 26 patients (68%) while it was discontinued due to intolerance in 10 patients (29%). At median molecular follow up of 25 months, nine patients (23.7%) had molecular relapse. Median SWMR was not reached and 2 year estimated SWMR was 65.2% (95%CI,47.2- 83.2). Of all relapses, 5/9 (55.5%) occurred in the first six months of TFR. On univariate analysis, duration of TKI and duration of DMR were predictive of molecular relapse. On multivariate analysis, none of these factors were found to be significant. This retrospective study suggests that for CML CP patients achieving deep molecular response, discontinuing TKI therapy in real-world settings may be feasible while potentially achieving comparable outcomes.

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Authors and Affiliations

  1. Department of Medical Oncology, Tata Memorial Hospital, Homi Bhaba National Institute, Mumbai, 400012, India

    Rup Jyoti Sarma, Anne Srikanth, Lingaraj Nayak, Hashmukh Jain, Manju Sengar & Bhausaheb Bagal

  2. Department of Medical Oncology, Dr DY Patil Medical College, Hospital and Research Centre, Dr DY Patil Vidyapeeth (Deemed to Be University), Pune, Maharashtra, India

    Lakhan Kashyap

  3. Consultant Medical Oncologist, AMRI Hospitals, Dhakuria, West Bengal, India

    Tanmoy Mondal

  4. Consultant Medical Oncologist, NH MMI Hospital, Raipur, Chhattisgarh, India

    Yashwant Kashyap

  5. Consultant Medical Oncologist, GEMS Medical College, Srikakulam, Andhra Pradesh, India

    Ravindra Nandhana

  6. Consultant Medical Oncologist, Kauvery Hospital, Chennai, Tamil Nadu, India

    Suresh Kumar Bondili

  7. Consultant Medical and Hemato-Oncologist, Asian Institute of Gastroenterology Hospital, Hyderabad, 500032, Telangana, India

    Avinash Bonda

  8. Department of Hematopathology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Center, Homi Bhaba National Institute, Mumbai, India

    Gaurav Chatterjee, Nikhil Vijay Patkar, Prashant Tembhare & Papagudi Subramanian

  9. Department of Hematopathology, Tata Memorial Hospital, Homi Bhaba National Institute, Mumbai, Maharashtra, India

    Sumeet Gujral

  10. Department of Hematology and Medical Oncology, St. Johns National Academy of Health Sciences, Bengaluru, India

    Hari Menon

  11. Department of Clinical Haematology, Tata Medical Center, Kolkata, West Bengal, India

    Reena Nair

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  1. Rup Jyoti Sarma
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Sarma, R.J., Kashyap, L., Srikanth, A. et al. Real World Outcomes with Treatment Free Remission in Chronic Myeloid Leukemia-Experience from a Tertiary Care Cancer Centre. Indian J Hematol Blood Transfus (2024). https://doi.org/10.1007/s12288-024-01777-z

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