Long-term treatment-free remission of chronic myeloid leukemia with falling levels of residual leukemic cells.

Autor: Ross DM; Cancer Theme, South Australian Health & Medical Research Institute, Adelaide, Australia. David.Ross@sa.gov.au.; Department of Haematology, Royal Adelaide Hospital and SA Pathology, Adelaide, Australia. David.Ross@sa.gov.au.; School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia. David.Ross@sa.gov.au.; Flinders University and Medical Centre, Adelaide, Australia. David.Ross@sa.gov.au.; Australasian Leukaemia and Lymphoma Group, Melbourne, Australia. David.Ross@sa.gov.au., Pagani IS; Cancer Theme, South Australian Health & Medical Research Institute, Adelaide, Australia.; School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia.; Australasian Leukaemia and Lymphoma Group, Melbourne, Australia., Shanmuganathan N; Cancer Theme, South Australian Health & Medical Research Institute, Adelaide, Australia.; Department of Haematology, Royal Adelaide Hospital and SA Pathology, Adelaide, Australia.; School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia.; Australasian Leukaemia and Lymphoma Group, Melbourne, Australia.; Genetic and Molecular Pathology, Centre for Cancer Biology, SA Pathology, Adelaide, Australia.; School of Pharmacy and Medical Science, University of South Australia, Adelaide, Australia., Kok CH; Cancer Theme, South Australian Health & Medical Research Institute, Adelaide, Australia.; School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia., Seymour JF; Australasian Leukaemia and Lymphoma Group, Melbourne, Australia.; Department of Haematology, Royal Melbourne Hospital and Peter MacCallum Centre, and University of Melbourne, Melbourne, Australia., Mills AK; Australasian Leukaemia and Lymphoma Group, Melbourne, Australia.; Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Australia., Filshie RJ; Australasian Leukaemia and Lymphoma Group, Melbourne, Australia.; Department of Haematology, St Vincent's Hospital, Melbourne, Australia., Arthur CK; Australasian Leukaemia and Lymphoma Group, Melbourne, Australia.; Department of Haematology, Royal North Shore Hospital, Sydney, Australia., Dang P; Cancer Theme, South Australian Health & Medical Research Institute, Adelaide, Australia., Saunders VA; Cancer Theme, South Australian Health & Medical Research Institute, Adelaide, Australia., Braley J; Genetic and Molecular Pathology, Centre for Cancer Biology, SA Pathology, Adelaide, Australia., Yong AS; Cancer Theme, South Australian Health & Medical Research Institute, Adelaide, Australia.; Department of Haematology, Royal Adelaide Hospital and SA Pathology, Adelaide, Australia.; School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia.; Australasian Leukaemia and Lymphoma Group, Melbourne, Australia., Yeung DT; Cancer Theme, South Australian Health & Medical Research Institute, Adelaide, Australia.; Department of Haematology, Royal Adelaide Hospital and SA Pathology, Adelaide, Australia.; School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia.; Australasian Leukaemia and Lymphoma Group, Melbourne, Australia., White DL; Cancer Theme, South Australian Health & Medical Research Institute, Adelaide, Australia.; School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia.; School of Biological Sciences, Faculty of Sciences, University of Adelaide, Adelaide, Australia.; School of Paediatrics, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia.; Health Sciences UniSA, Adelaide, Australia., Grigg AP; Australasian Leukaemia and Lymphoma Group, Melbourne, Australia.; Department of Clinical Haematology, Austin Hospital and Olivia Newton John Cancer Research Institute, Melbourne, Australia., Schwarer AP; Australasian Leukaemia and Lymphoma Group, Melbourne, Australia.; Department of Haematology, The Alfred Hospital and Box Hill Hospital, Melbourne, Australia., Branford S; School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia.; Genetic and Molecular Pathology, Centre for Cancer Biology, SA Pathology, Adelaide, Australia.; School of Pharmacy and Medical Science, University of South Australia, Adelaide, Australia.; School of Biological Sciences, Faculty of Sciences, University of Adelaide, Adelaide, Australia., Hughes TP; Cancer Theme, South Australian Health & Medical Research Institute, Adelaide, Australia.; Department of Haematology, Royal Adelaide Hospital and SA Pathology, Adelaide, Australia.; School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia.; Australasian Leukaemia and Lymphoma Group, Melbourne, Australia.
Jazyk: angličtina
Zdroj: Leukemia [Leukemia] 2018 Dec; Vol. 32 (12), pp. 2572-2579. Date of Electronic Publication: 2018 Oct 12.
DOI: 10.1038/s41375-018-0264-0
Abstrakt: Following the achievement of deep molecular response on tyrosine kinase inhibitors (TKIs), approximately half of patients with chronic myeloid leukemia (CML) can discontinue TKI and remain in treatment-free remission (TFR). The ALLG CML8 study enrolled 40 imatinib-treated patients with undetectable BCR-ABL1 mRNA (approximately MR 4.5 ). Molecular relapse was defined as detectable BCR-ABL1 on two consecutive tests or any single value >0.1%. With a median follow-up of 8.6 years (range 5.7-11.2 years), 18 patients remain in continuous TFR (45.0%; 95% confidence interval 31.9-63.4%). The latest relapse detected was 27 months after stopping imatinib. No patient progressed to advanced phase. Twenty-two patients met criteria for imatinib re-treatment and all regained undetectable molecular response. Nine patients in long-term TFR were monitored by highly sensitive individualized BCR-ABL1 DNA PCR in a sufficient number of samples to enable more precise quantification of residual leukemia. BCR-ABL1 DNA decreased from a median of MR 5.0 in the first year of TFR to MR 6.1 in the sixth year of TFR. Our results support the long-term safety and remarkable stability of response after imatinib discontinuation in appropriately selected CML patients. Serial high sensitivity testing provides a new and unexpected finding of gradually reducing CML cells in patients in long-term TFR.
Databáze: MEDLINE
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