Rea Delphine, Cayuela Jean-Michel
Service d'hématologie Adulte, Unité INSERM, UMR-1160 and France Intergroupe des Leucémies Myéloïdes Chroniques (Fi-LMC), Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France.
Laboratoire Central d'Hématologie, EA3518 Université Paris 7 and France Intergroupe des Leucémies Myéloïdes Chroniques (Fi-LMC), Hôpital Saint-Louis, Paris, France.
Int J Hematol. 2018 Oct;108(4):355-364. doi: 10.1007/s12185-017-2295-0. Epub 2017 Jul 8.
Clinical trials have formally demonstrated that in chronic myeloid leukemia (CML), patients treated with tyrosine kinase inhibitors (TKI) who achieved and maintained deep molecular responses could discontinue their treatment after several years without facing overt signs of disease relapse in approximately 50% of the cases. In patients with a molecular relapse, prompt re-introduction of TKI therapy was able to rapidly restore deep molecular responses. The concept of a lifelong therapy with TKI has thus been challenged and treatment-free remission (TFR) strategies will soon integrate clinical practice, providing that safe recommendations will be established. In this article, we give an update on TKI discontinuation studies in CML and we also provide an overview of upcoming TFR clinical and biological challenges.
临床试验已正式证明，在慢性粒细胞白血病（CML）中，接受酪氨酸激酶抑制剂（TKI）治疗并实现并维持深度分子反应的患者，数年后可停药，约50%的病例不会出现明显的疾病复发迹象。在分子复发的患者中，迅速重新引入TKI治疗能够迅速恢复深度分子反应。因此，TKI终身治疗的概念受到了挑战，无治疗缓解（TFR）策略将很快融入临床实践，前提是要制定出安全的建议。在本文中，我们提供了CML中TKI停药研究的最新情况，并且还概述了即将到来的TFR临床和生物学挑战。
