Keywords
TFR
Real World
How to Cite
Abstract
Obtaining deep molecular responses to consider treatment discontinuation is today one of the objectives in chronic myeloid leukemia (CML). The benefit is associated not only with improvement in patients quality of life, but also with the impact of becoming independent from a chronic treatment and its late adverse events. Of the total number of patients with CML, a very select group will be able to remain in treatment free remission (TFR). Only 30% of patients will be able to meet the criteria for discontinuation and of them, 50% will present a recurrence of the disease. Although clinical trials have demonstrated that discontinuation is possible and safe in patients who have obtained deep and sustained molecular responses, they do not reflect real-life cohorts and their results are not applicable to all patients. The ideal condition to carry out discontinuation in our region is under a research protocol, however, certain conditions push it to be carried out outside of it. The irreplaceable conditions to consider when discontinuing treatment in clinical practice are: ensuring the performance of serial post-discontinuation molecular monitoring on an international scale adapted to published recommendations or guidelines. Ensure that all recommended criteria are met for safe discontinuation. Take time to explain the patient the pros and cons of discontinuation. Although sequential molecular monitoring is critical for detecting patients with relapse, prediction accuracy remains a challenge. There is currently little data regarding the possible contributing role of the immune system in patients who achieve a deep molecular response with tyrosine quinase inhibitors (TKI). The high cost of TKIs, their prolonged treatment and the increase in patients survival with the consequent increase in the prevalence of the disease, have a high financial impact. In our region, it is impossible to talk about discontinuing treatment in CML if molecular monitoring is not considered as the main tool that should be guaranteed to the patient from diagnosis, follow-up and post-discontinuation. Considering the redirection of saved resources to treatment to cover this unmet need is today an unresolved issue in Argentina.
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