Termination of the treatment in chronic myeloid leukemia - possi bility of stopping the tyrosine kinase inhibitors
Abstract
Presently tyrosine kinase inhibitors (TKI) represent the standard treatment of patients with chronic myeloid leukemia (CML) who frequently achieve long-term molecular response. Despite the fact that the actual guidelines recommend continual treatment of CML with TKI within controlled clinical trials patients who stopped the treatment after achievement of a deep molecular had 40% probability to remain in continual response without the need of reintroduction of the therapy.
Stopping the treatment is feasible, however, there is a need to define the patients in whom the termination of the treatment with TKI will be safe. Minimization of the side-effects, improvement of the quality of life and lowering the selection pressure for development of the BCR-ABL1 kinase domain may be anticipated.
Economical impact from anticipated lowering of the cost will be also important. Despite the very optimistic results achieved safe stopping of TKI treatinent is possible only within controlled clinical trials.
In routine clinical praxis this approach will be feasible only after the implantation into the CML treatment guidelines. The possibility to terminate the treatment of CML will be important for the patients as well as for healthcare systems and the whole society.