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Minimal Residual Disease and Discontinuation of Therapy in Chronic Myeloid Leukemia: Can We Aim at a Cure?

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#1 valiantchong


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Posted 21 December 2011 - 11:22 AM



Various strategies might improve the odds of drug-free remission of CML, and some of these have already been used in clinical                     trials. Given the excellent safety and tolerability of TKI therapy, the safety of any novel treatment for this patient group                     is of paramount importance. Any augmentation of TKI therapy must carry a risk of new, additional, or unexpected toxicity,                     and this risk must be balanced against the potential benefit. The same consideration of patient safety applies to a therapeutic                     test of TKI withdrawal. It is essential that careful monitoring is undertaken to detect relapse as early as possible so that                     effective TKI therapy may be reinstituted. It is therefore recommended that, at present, such approaches are only considered                     in the context of carefully designed, controlled clinical trials.                 

Sustained CMR after withdrawal of TKIs is a therapeutic success that many clinicians and scientists would not have anticipated                     when IM treatment was first introduced. By analogy with the treatment of HIV with antiretroviral drugs, it seemed likely that                     even a highly effective targeted treatment would need to be continued indefinitely to suppress the CML clone. Perhaps contrary                     to expectation, this is not always the case in chronic-phase CML. Early and deep response translates to long-term disease                     control with the potential for safe withdrawal of treatment in carefully selected patients. The challenges now are to identify                     those patients in whom treatment can safely be withdrawn, and to increase the number of patients eligible for withdrawal of                     therapy.                 

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