Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Cancer Med. 2023 Aug;12(16):17239-17252. doi: 10.1002/cam4.6296. Epub 2023 Jul 6.
Treatment-free remission (TFR) has become the main target for chronic myeloid leukemia (CML). Tyrosine kinase inhibitors (TKI) dose optimization is crucial in managing adverse events, and improving adherence in clinical practice. In persons achieving a deep molecular response (DMR), some data suggest TKI dose reduction before discontinuation does not change success rate of achieving TFR, but this is controversial. However, data on quality-of-life (QoL) and mental health in CML patients with full-dose TKI, low-dose TKI, and TKI discontinuation are limited. Moreover, recent evidence indicating the feasibility of TKI dose reduction and discontinuation after dose reduction, which may change CML patients' perspectives on TKI discontinuation.
We conducted a cross-sectional study using online questionnaires to explore the QoL, mental health in patients with diverse TKI dose, and perspective on TKI dose reduction as a prelude to discontinuation.
1450 responses were included in the analysis. 44.3% of respondents reported a moderate-to-severe impact of TKI treatment on their QoL. 17% of respondents had moderate-to-severe anxiety. 24.4% of respondents had moderate-to-severe depression. In 1326 patients who had not discontinued their medication, 1055 (79.6%) patients reported they would try TKI discontinuation because of concerns over side effects of long-term medication (67.9%), financial burden (68.7%), poor QoL (77.9%), pregnancy needs (11.6%), anxiety and depression while taking TKI (20.8%), inconvenience of TKI treatment (22.2%). 613 of 817 (75.0%) patients on full-dose TKI therapy indicated they preferred trying a dose reduction before discontinuing TKI therapy after dose reduction compared with 31 (3.8%) preferring no dose reduction before stopping.
TKI dose reduction showed a significant improvement of patients' QoL and mental health, comparable to the effect of TKI discontinuation. Most patients indicated they preferred dose reduction before stopping TKI therapy. In clinical practice, TKI dose reduction can be considered as a bridge from full-dose treatment to discontinuation. Our results showed that tyrosine kinase inhibitors (TKI) dose reduction showed a significant improvement of patients' quality-of-life and mental health, comparable to the effect of TKI discontinuation. Most patients desire to discontinue TKI in the future. TKI discontinuation after dose reduction is more acceptable compared to discontinuing it directly. In clinical practice, TKI dose reduction can be considered as a bridge from full-dose treatment to discontinuation. Please do not hesitate to contact me in case further clarification is needed with this submission.
无治疗缓解（TFR）已成为慢性髓性白血病（CML）的主要目标。优化酪氨酸激酶抑制剂（TKI）剂量对于管理不良反应和提高临床实践中的依从性至关重要。在达到深度分子反应（DMR）的患者中，一些数据表明，在停药前减少 TKI 剂量不会改变实现 TFR 的成功率，但这存在争议。然而，关于接受全剂量 TKI、低剂量 TKI 和 TKI 停药的 CML 患者的生活质量（QoL）和心理健康的数据有限。此外，最近的证据表明 TKI 剂量减少和剂量减少后的停药是可行的，这可能会改变 CML 患者对 TKI 停药的看法。
我们使用在线问卷进行了一项横断面研究，以探讨不同 TKI 剂量患者的 QoL 和心理健康状况，以及对 TKI 剂量减少作为停药前奏的看法。
共纳入 1450 份回复进行分析。44.3%的受访者报告 TKI 治疗对其 QoL 有中度至重度影响。17%的受访者有中度至重度焦虑。24.4%的受访者有中度至重度抑郁。在 1326 名未停药的患者中，1055 名（79.6%）患者表示，由于担心长期用药的副作用（67.9%）、经济负担（68.7%）、QoL 差（77.9%）、怀孕需求（11.6%）、服用 TKI 时的焦虑和抑郁（20.8%）、TKI 治疗不便（22.2%），他们会尝试停药。613 名接受全剂量 TKI 治疗的患者中有 613 名（75.0%）表示，他们更倾向于在停药前尝试减少剂量，而不是在停药前减少 31 名（3.8%）剂量。
TKI 剂量减少显著改善了患者的 QoL 和心理健康，与 TKI 停药的效果相当。大多数患者表示，他们更倾向于在停止 TKI 治疗前先减少剂量。在临床实践中，TKI 剂量减少可作为从全剂量治疗到停药的桥梁。我们的结果表明，与 TKI 停药相比，TKI 剂量减少显著改善了患者的生活质量和心理健康，大多数患者希望在未来停止使用 TKI。与直接停药相比，剂量减少后停药更容易被接受。在临床实践中，TKI 剂量减少可作为从全剂量治疗到停药的桥梁。如果对本次提交有进一步的澄清，请随时与我联系。
