Cargando…

Treatment-Free Remission: the New Goal in CML Therapy

PURPOSE OF REVIEW: Treatment-free remission (TFR) is considered one of the main goals of therapy in patients with CML. Our goal in this paper is to review the current data on TFR, and discuss future directions. RECENT FINDINGS: Multiple studies have demonstrated that attempting a treatment-free remi...

Descripción completa

Detalles Bibliográficos
Autores principales: Atallah, Ehab, Sweet, Kendra
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8495665/
https://www.ncbi.nlm.nih.gov/pubmed/34618317
http://dx.doi.org/10.1007/s11899-021-00653-1
_version_ 1784579593032695808
author Atallah, Ehab
Sweet, Kendra
author_facet Atallah, Ehab
Sweet, Kendra
author_sort Atallah, Ehab
collection PubMed
description PURPOSE OF REVIEW: Treatment-free remission (TFR) is considered one of the main goals of therapy in patients with CML. Our goal in this paper is to review the current data on TFR, and discuss future directions. RECENT FINDINGS: Multiple studies have demonstrated that attempting a treatment-free remission is safe and effective in a select group of patients. More recent data suggested that undetectable BCR-ABL1 by digital PCR prior to discontinuation is highly predictive of successful TFR. However, some patients have a successful TFR with no evidence of clinical disease despite persistent detectable BCR-ABL1. Some recent studies have shed some more light on possible mechanisms for this phenomena. Some possible mechanisms include immune mechanism, BCR-ABL1 detected in the lymphoid component only, or stem cell exhaustion. SUMMARY: TFR should be discussed with patients with CML. Patients who achieve a sustained deep molecular response may be eligible to attempt TFR, however, setting expectations that overall only 20% of patients with newly diagnosed CML will achieve a successful TFR. The importance of compliance to treatment early on cannot be overemphasized. Further studies using other drugs to get patients to a deeper remission in order to be eligible for TFR attempt, or attempting a second TFR in patients who had disease recurrence after first TFR attempt, are currently underway.
format Online
Article
Text
id pubmed-8495665
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Springer US
record_format MEDLINE/PubMed
spelling pubmed-84956652021-10-08 Treatment-Free Remission: the New Goal in CML Therapy Atallah, Ehab Sweet, Kendra Curr Hematol Malig Rep Chronic Myeloid Leukemias (MJ Mauro and G Saglio, Section Editors) PURPOSE OF REVIEW: Treatment-free remission (TFR) is considered one of the main goals of therapy in patients with CML. Our goal in this paper is to review the current data on TFR, and discuss future directions. RECENT FINDINGS: Multiple studies have demonstrated that attempting a treatment-free remission is safe and effective in a select group of patients. More recent data suggested that undetectable BCR-ABL1 by digital PCR prior to discontinuation is highly predictive of successful TFR. However, some patients have a successful TFR with no evidence of clinical disease despite persistent detectable BCR-ABL1. Some recent studies have shed some more light on possible mechanisms for this phenomena. Some possible mechanisms include immune mechanism, BCR-ABL1 detected in the lymphoid component only, or stem cell exhaustion. SUMMARY: TFR should be discussed with patients with CML. Patients who achieve a sustained deep molecular response may be eligible to attempt TFR, however, setting expectations that overall only 20% of patients with newly diagnosed CML will achieve a successful TFR. The importance of compliance to treatment early on cannot be overemphasized. Further studies using other drugs to get patients to a deeper remission in order to be eligible for TFR attempt, or attempting a second TFR in patients who had disease recurrence after first TFR attempt, are currently underway. Springer US 2021-10-07 2021 /pmc/articles/PMC8495665/ /pubmed/34618317 http://dx.doi.org/10.1007/s11899-021-00653-1 Text en © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Chronic Myeloid Leukemias (MJ Mauro and G Saglio, Section Editors)
Atallah, Ehab
Sweet, Kendra
Treatment-Free Remission: the New Goal in CML Therapy
title Treatment-Free Remission: the New Goal in CML Therapy
title_full Treatment-Free Remission: the New Goal in CML Therapy
title_fullStr Treatment-Free Remission: the New Goal in CML Therapy
title_full_unstemmed Treatment-Free Remission: the New Goal in CML Therapy
title_short Treatment-Free Remission: the New Goal in CML Therapy
title_sort treatment-free remission: the new goal in cml therapy
topic Chronic Myeloid Leukemias (MJ Mauro and G Saglio, Section Editors)
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8495665/
https://www.ncbi.nlm.nih.gov/pubmed/34618317
http://dx.doi.org/10.1007/s11899-021-00653-1
work_keys_str_mv AT atallahehab treatmentfreeremissionthenewgoalincmltherapy
AT sweetkendra treatmentfreeremissionthenewgoalincmltherapy