CML-158: Analysis of TKI Discontinuation in Tunisian Chronic Myeloid Leukemia Patients

Abstract

Context Discontinuation of tyrosine kinase inhibitor (TKI) therapy to achieve a treatment-free remission (TFR) has become an important goal in routine clinical practice for patients with chronic myeloid leukemia (CML) in sustained deep molecular remission (DMR). Objective The aim of this study was to evaluate discontinuations of tyrosine kinase inhibitor (TKI) treatment in Tunisian patients with chronic myeloid leukemia (CML). Design This retrospective study collected data of CML patients who had discontinued ITK treatment as part of daily clinical practice in Sfax, Tunisia. Setting University Hospital. Patients or other participants 14 Tunisian CML patients who discontinued TKIs were followed. Interventions Quantitative assessment of the BCR-ABL transcript was performed using the Cepheid Xpert BCR-ABL ultra assay. Main outcome measures Duration of TKI therapy, depth of molecular response, and the reasons for TKI discontinuation were collected. Results In our series, 13 patients and one discontinued imatinib and second-generation TKIs, respectively. Discontinuation was programmed in 11 patients (78.5%) and 3 discontinued for other reasons (1 for adverse effects and 2 for pregnancy). 5 patients (35.7%) experienced a molecular relapse defined as the loss of a major molecular response (MMR). Relapses occurred after a mean time of 7 months (range: 1-21). For the 9 patients (64.2%) who maintain a TFR, mean duration of TKI therapy before discontinuation was 120 months, with a mean follow-up after discontinuation of 30.69 months. Conclusions Despite the limit of our study, these results highlight the importance of sustained deep molecular responses to safely suspend therapy and attempt treatment-free remission (TFR).