Annunziata Mario, Bonifacio Massimiliano, Breccia Massimo, Castagnetti Fausto, Gozzini Antonella, Iurlo Alessandra, Pregno Patrizia, Stagno Fabio, Specchia Giorgina
Hematology Division, AORN Cardarelli-Napoli, Naples, Italy.
Section of Hematology, Department of Medicine, University of Verona, Verona, Italy.
Front Oncol. 2020 Jun 2;10:883. doi: 10.3389/fonc.2020.00883. eCollection 2020.
The treatment of chronic myeloid leukemia (CML) has been radically changed by the approval of tyrosine kinase inhibitors (TKIs), which target BCR-ABL1 kinase activity. CML is now managed as a chronic disease requiring long-term treatment and close molecular monitoring. It has been shown that in a substantial number of patients who have achieved a stable deep molecular response (DMR), TKI treatment can be safely discontinued without loss of response. Therefore, treatment-free remission (TFR), through the achievement of a DMR, is increasingly regarded as a feasible treatment goal in many CML patients. However, only nilotinib has approval in this setting and a number of controversial aspects remain regarding treatment choices and timings, predictive factors, patient communication, and optimal strategies to achieve successful TFR. This narrative review aims to provide a comprehensive overview on how to optimize the path to DMR and TFR in patients with CML, and discusses recent data and future directions.
酪氨酸激酶抑制剂(TKIs)的获批从根本上改变了慢性髓性白血病(CML)的治疗方式,这类抑制剂可靶向作用于BCR-ABL1激酶活性。如今,CML被当作一种需要长期治疗和密切分子监测的慢性病来管理。研究表明,在大量已实现稳定深度分子反应(DMR)的患者中,可以安全地停用TKI治疗且不会丧失疗效。因此,通过实现DMR来达到无治疗缓解(TFR),在许多CML患者中越来越被视为一个可行的治疗目标。然而,在此情况下只有尼罗替尼获得了批准,在治疗选择和时机、预测因素、患者沟通以及实现成功TFR的最佳策略等方面仍存在一些争议。本叙述性综述旨在全面概述如何优化CML患者实现DMR和TFR的路径,并讨论最新数据和未来方向。