CML is a relatively rare form of blood cancer which occurs when the bone marrow produces too many white blood cells (myeloid cells) that are not fully developed and function poorly.1 The overproduction of these cells prevents the bone marrow from producing enough healthy blood cells.
Advances in treatment have helped to transform CML from a life-threatening disease to, in most cases, a chronic condition, and in the last decade mortality rates have decreased by a fifth in the UK.2 CML is now commonly treated with TKIs, which help stop the production of the abnormal white blood cells.3 Around 85–95% of people treated with TKIs will live for at least 5 years after CML is diagnosed.1 Other therapies for CML include chemotherapy and, in some cases, stem cell or bone marrow transplants.3
One of the new emerging goals of CML management for some patients is TFR. For those patients who respond very well to treatment, their leukaemic burden is reduced to a level at which they may be able to stop treatment. In order to be considered for attempting TFR, a patient must have demonstrated a sustained deep molecular response prior to stopping TKI therapy. Discontinuation for TFR requires strict eligibility criteria and increased frequency of monitoring.4–6 The decision to stop TKI therapy should only be attempted in consultation with the patient’s clinician and under strict, frequent monitoring in a clinical setting. Treatment should be reinitiated within 4 weeks if a patient loses their response while in TFR.4,5
CML, chronic myeloid leukaemia; TFR, treatment-free remission; TKI, tyrosine kinase inhibitor.
NHS Choices. Chronic myeloid leukaemia: Overview. Available at: http://www.nhs.uk/Conditions/Leukaemia-chronic/Pages/Introduction.aspx. Last accessed May 2020.
Cancer Research UK. Chronic myeloid leukaemia (CML) statistics. Available at: http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/leukaemia-cml#heading-Zero. Last accessed May 2020.
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Hochhaus A, et al. Ann Oncol. 2017;28(suppl 4):iv41–iv51.