Update on Treatment-Free Remission in CML

Abstract

Introduction Treatment-free remission (TFR) is one of the main goals of chronic myeloid leukemia (CML) therapy. Tyrosine kinase inhibitor (TKI) discontinuation should be considered in eligible patients for several reasons. Patients with CML on TKI have a reduced quality of life.1 TKIs are associated with long-term side effects, such as cardiovascular and renal complications.2 TKIs are associated with a heavy financial burden, both to patients and society. Numerous studies with thousands of patients have demonstrated the safety and feasibility of attempting TKI discontinuation.3–7 Finally, TKI discontinuation is an important goal for children diagnosed with CML due to long-term side effects and effects on growth and development.8 With current TKIs, approximately 50% of patients will be eligible for attempting TFR. Of those, only 50% will achieve a successful TFR. So, in reality, only 20% of patients with newly diagnosed CML will achieve a successful TFR, and the majority of patients will need to continue TKI therapy indefinitely.