Making Treatment-Free Remission (TFR) Easier in Chronic Myeloid Leukemia: Fact-Checking and Practical Management Tools
| Autor: | Maria Cristina Miggiano, Marzia Salvucci, Massimiliano Bonifacio, Elisabetta Calistri, Monica Poggiaspalla, Gianni Binotto, Atto Billio, Claudia Minotto, Alessandro Lucchesi, Elena Trabacchi, Francesco Cavazzini, Anna Merli, Mauro Krampera, Sara Galimberti, Antonella Gozzini, Isabella Capodanno, Gabriele Gugliotta, Barbara Scappini, Mario Tiribelli, Gianantonio Rosti, Monica Crugnola, Fausto Castagnetti |
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| Přispěvatelé: | Castagnetti F., Binotto G., Capodanno I., Billio A., Calistri E., Cavazzini F., Crugnola M., Gozzini A., Gugliotta G., Krampera M., Lucchesi A., Merli A., Miggiano M.C., Minotto C., Poggiaspalla M., Salvucci M., Scappini B., Tiribelli M., Trabacchi E., Rosti G., Galimberti S., Bonifacio M. |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Cancer Research
medicine.medical_specialty Standard of care Fact checking Socio-culturale Disease chronic-phase chronic myeloid leukemia tyrosine kinase inhibitors treatment-free remission Leukemia Myelogenous Chronic BCR-ABL Positive Early prediction medicine Humans Pharmacology (medical) Intensive care medicine Protein Kinase Inhibitors business.industry Remission Induction Therapy in Practice Myeloid leukemia Female sex Prognosis Discontinuation Treatment Outcome Oncology Disease risk Female business |
| Zdroj: | Targeted Oncology |
| Popis: | In chronic-phase chronic myeloid leukemia (CML), tyrosine kinase inhibitors (TKIs) are the standard of care, and treatment-free remission (TFR) following the achievement of a stable deep molecular response (DMR) has become, alongside survival, a primary goal for virtually all patients. The GIMEMA CML working party recently suggested that the possibility of achieving TFR cannot be denied to any patient, and proposed specific treatment policies according to the patient’s age and risk. However, other international recommendations (including 2020 ELN recommendations) are more focused on survival and provide less detailed suggestions on how to choose first and subsequent lines of treatment. Consequently, some grey areas remain. After literature review, a panel of Italian experts discussed the following controversial issues: (1) early prediction of DMR and TFR: female sex, non-high disease risk score, e14a2 transcript and early MR achievement have been associated with stable DMR, but the lack of these criteria is not sufficient to exclude any patient from TFR; (2) criteria for first and subsequent line therapy choice: a number of patient and drug characteristics have been proposed to make a personalized decision; (3) monitoring of residual disease after discontinuation: after the first 6 months, the frequency of molecular tests can be reduced based on MR4.5 persistence and short turnaround time; (4) prognosis of TFR: therapy and DMR duration are important to predict TFR; although immunological control of CML plays a role, no immunological predictive phenotype is currently available. This guidance is intended as a practical tool to support physicians in decision making. |
| Databáze: | OpenAIRE |
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