AI Article Synopsis

  • In the past decade, targeted kidney inhibitors (TKIs) have significantly improved the survival rates of chronic myeloid leukemia (CML) patients, particularly those achieving deep and sustained molecular response (DMR), allowing some to consider stopping treatment.
  • A study analyzed responses from 1,777 CML patients in Italy, focusing on the impact of different TKIs (imatinib, dasatinib, nilotinib) and timing of responses (3, 6, and 12 months).
  • Results showed that patients achieving certain molecular response benchmarks at 3 months were more likely to achieve DMR later, with significant differences in outcomes based on the specific TKI used.

Article Abstract

Background: In the last decade, TKIs improved the overall survival (OS) of chronic myeloid leukemia (CML) patients who achieved a deep and sustained molecular response (DMR, defined as stable MR4 and MR4.5). Those patients may attempt therapy discontinuation. In our analysis, we report the differences in eligibility criteria due to time of response and different TKI used as frontline treatment analyzed in a large cohort of CP-CML patients.

Methods: Data were exported by LabNet CML, a network founded by GIMEMA in 2014. The network standardized and harmonized the molecular methodology among 51 laboratories distributed all over Italy for the diagnosis and molecular residual disease (MRD) monitoring.

Results: Out of 1777 patients analyzed, 774 had all evaluable timepoints (3, 6, and 12 months). At 3 months, 40 patients obtained ≥MR4: of them 14 (3.6%) with imatinib, 8 (5.8%) with dasatinib, and 18 (7.4%) with nilotinib (P = .093); at 6 months, 146 patients were in MR4: 42 (11%) with imatinib, 38 (28%) with dasatinib, and 66 (27%) with nilotinib (P < .001). At 12 months, 231 patients achieved a DMR: 85 (22%) with imatinib, 55 (40%) with dasatinib and 91 (38%) with nilotinib (P < .001). Achieving at least ≥MR2 at 3 months, was predictive of a DMR at any timepoint of observation: with imatinib 67% versus 30% of patients with 2 years was significant for patients who at 3 months had ≥MR2 (18% vs. 9.9% of pts with
Conclusion: In conclusion, reaching ≥MR2 and a MR3 at 3 months it seems predictive of a DMR at any time point. Considering the prerequisite for a discontinuation with a sustained DMR only a minority of patients can be eligible for the discontinuation, regardless the frontline treatment received.

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Source
http://dx.doi.org/10.1016/j.clml.2024.08.009DOI Listing

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