Leukaemia Laboratory, Precision Medicine Theme, South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia.
Nat Rev Clin Oncol. 2020 Aug;17(8):493-503. doi: 10.1038/s41571-020-0367-1. Epub 2020 May 6.
In the past few years, international treatment guidelines for chronic myeloid leukaemia have incorporated recommendations for attempting discontinuation of treatment with tyrosine-kinase inhibitors (TKIs) outside of the setting of a clinical trial with the aim of a treatment-free remission (TFR). Physicians involved in the treatment of chronic myeloid leukaemia need to be sufficiently well informed to guide patients through decision-making about the discontinuation of treatment with TKIs targeting BCR-ABL1 by providing a balanced assessment of the potential risks and benefits of stopping or continuing therapy. These guidelines also seek to ensure that the risks associated with being off treatment are kept to a minimum. In this Review, we summarize the clinical studies of TFR and how their results can guide routine clinical practice with a focus on specific aspects such as molecular monitoring and the pregnancy-specific risks associated with a TFR attempt in female patients. We also address the development of predictors of outcome after TKI discontinuation and present strategies that warrant further consideration to enable more patients to enter TFR.
在过去的几年中，慢性髓性白血病的国际治疗指南已经纳入了在临床试验之外尝试停止酪氨酸激酶抑制剂（TKI）治疗的建议，目的是实现无治疗缓解（TFR）。参与慢性髓性白血病治疗的医生需要充分了解情况，以便通过对停止针对 BCR-ABL1 的 TKI 治疗的潜在风险和益处进行平衡评估，为患者提供决策指导。这些指南还旨在确保将停药相关风险降至最低。在这篇综述中，我们总结了 TFR 的临床研究，以及它们的结果如何指导常规临床实践，重点关注分子监测和女性患者 TFR 尝试相关的妊娠特定风险等特定方面。我们还讨论了 TKI 停药后结局预测因子的发展，并提出了一些值得进一步考虑的策略，以使更多的患者能够进入 TFR。
