2 research outputs found
Deâescalation or discontinuation of tyrosine kinase inhibitor in patients with chronic myeloid leukemia: A multicentral, openâlabel, prospective trial in China
Abstract Background: Longâterm treatmentâfree remission (TFR) represents a new goal for chronic myeloid leukemia (CML). Optimizing dose of tyrosine kinase inhibitors (TKIs) in the CML treatment maybe a new challenge to maintain effective and improving patientsâ quality of life. We hypothesized that administration of lowâdose TKIs does not compromise major molecular response (MMR) in patients with CML who have a deep molecular response (DMR). Methods: We did an openâlabel, randomized trial at eight hospitals in China. Eligible CMLâCP patients (aged 18â70 years) had shown continuous response to TKI more than 5 years and maintained MR4.5 (BCRâABLIS †0.0032%) in recent 18 months. Patients were randomly assigned (1:1) to the TKI deâescalation group or the discontinuation group. Randomization was done with permuted blocks (block size four) and implemented through an interactive webâbased randomization system. Recurrence was defined as the single sample with real time Quantitative PCR (RTâqPCR) measurement greater than 0.1% (MMR). The primary endpoint was 12âmonth MMR rate in patients who received deâescalation or discontinuation of TKIs. This study was registered at ClinicalTrials.gov (NCT04143087). Results: Around 125 patients were enrolled between October 23, 2019 and October 31, 2020, 62 patients received dose deâescalation of TKIs, while 63 patients in the discontinuation group. In the deâescalation group, molecular recurrenceâfree survival at 12 months was 88.32% (95% CI 79%â98%), whereas molecular recurrenceâfree survival in the discontinuation group at 12 months was 59.98% (95% CI 47â73). No progressions occurred at the data cutâoff date. All 29 recurrence cases restart TKI treatment returned to MMR. Cytolytic NK cells as a proportion of lymphocyte cells were significantly increased from baseline after 6 months whether in the deâescalation or TKIs cessation group (P = 0.048, 0.001, respectively); compared with the relapsing patients, Tregs proportion was decreased (P = 0.003), and higher proportion of NK cells were found in nonârelapsing patients whether in TKI deâescalation or discontinuation group (P = 0.011, 0.007, respectively). We also found that the deâescalation group showed better diseaseâspecific HRQOL in regards to its impact on emotional functioning, fatigue, pain, and financial difficulties. Conclusion: With 88.32% MMR in 12âmonths followâup after deâescalation TKIsâ treatment, doseâhalving could become a new treatment paradigm for CML patients who with DMR under continuing maintenance therapy with TKIs