Abstract
Treatment with a BCR::ABL1 targeted tyrosine kinase inhibitor (TKI) has afforded a near-normal life expectancy for most patients with chronic myelogenous leukemia (CML). Approximately half of CML patients achieve a deep molecular response with TKI therapy and can discontinue treatment. In these patients, the CML can remain in prolonged remission, and patients can experience an improvement in quality of life.
The European Leukemia Network (ELN) and the National Comprehensive Cancer Network (NCCN) provide the most up-to-date frameworks for treatment-free trials (TFTs), reflecting best practices from over 13 clinical trials published since the concept first entered the CML vernacular around 2010. Provincial guidelines also exist, such as those published in Quebec by the Groupe Québécois de Recherche en LMC-NMP (the Chronic Myeloid Leukemia and Myeloproliferative Neoplasms Quebec Research Group).
The discontinuation of therapy for patients with CML in deep remission marks a potential shift from the management of CML as a chronic illness to the potential for a curative approach to CML. However, for now, only 50% of eligible patients have undergone successful TFT; optimal patient selection and monitoring is required to ensure the best outcomes with such a management strategy.