TREATMENT-FREE REMISSION AFTER SECOND-STOP OF IMATINIB THERAPY IN PATIENTS WITH CHRONIC MYELOID LEUKEMIA IN CHRONIC PHASE
Author(s): ,
Sukjoong Oh
Affiliations:
Internal Medicine,Kangbuk Samsung Hospital, Sungkyunkwan University,Seoul,Korea, Republic Of
,
Sung-Eun Lee
Affiliations:
Hematology,Seoul St. Mary's Hospital, The Catholic University of Korea,Seoul,Korea, Republic Of
,
Soo-Young Choi
Affiliations:
Hematology,Seoul St. Mary Hospital,The Catholic University of Korea,Seoul,Korea, Republic Of
,
Soo-Hyun Kim
Affiliations:
Hematology,Seoul St. Mary's Hospital, The Catholic University of Korea,Seoul,Korea, Republic Of
,
Sung-Hyun Kim
Affiliations:
Internal Medicine,Dong-A University College of Medicine,Pusan,Korea, Republic Of
,
Dae Young Zang
Affiliations:
Internal Medicine,Hallym University College of Medicine,Anyang,Korea, Republic Of
,
Young Rok Do
Affiliations:
Hematology-Oncology,Keimyung University Hospital,Daegu,Korea, Republic Of
,
Jae-Yong Kwak
Affiliations:
Hematology,Chonbuk National University Hospital,Jeonju,Korea, Republic Of
,
Jeong-A Kim
Affiliations:
Hematology,St. Vincent Hospital,Suwon,Korea, Republic Of
Dong-Wook Kim
Affiliations:
Hematology,Seoul St. Mary Hospital, The Catholic University of Korea,Seoul,Korea, Republic Of
EHA Library. Oh S. Jun 16, 2018; 215433; PS1119
Prof. Dr. Sukjoong Oh
Prof. Dr. Sukjoong Oh
Contributions
Abstract

Abstract: PS1119

Type: Poster Presentation

Presentation during EHA23: On Saturday, June 16, 2018 from 17:30 - 19:00

Location: Poster area

Background
Based on the accumulated results from clinical trials during the last 10 years, it is known that about 50% of chronic phase chronic myeloid leukemia (CP CML) patients with sustained deep molecular responses after enough tyrosine kinase inhibitors (TKIs) therapy may successfully stop their TKI therapy. Consequently, treatment-free remission (TFR) has been a new therapeutic goal. However, for the patients who relapsed after imatinib (IM) discontinuation, the questions on the best type of TKI for reintroducing and possibility of a second TKI discontinuation attempt are not clear. 

Aims
We analyzed data from patients who regained durable deep molecular response after IM resumption for relapse and stopped IM therapy again in the Korean multicenter prospective study (Korean Imatinib Discontinuation Study; KID Study).

Methods
CP CML patients who were treated with IM for more than 3 years and had undetectable levels of BCR-ABL1 transcripts determined by quantitative reverse transcriptase polymerase chain reaction (PCR) for at least 2 years were eligible for KID study and in cases of MMR loss after 2 consecutive assessments, IM treatment was re-introduced. After IM resumption for MMR loss, the molecular response was evaluated every month until MMR was re-achieved and every 3 months thereafter. The second stop was permitted in the patients who were in second UMRD for at least 2 years.

Results
Among patients who lost MMR in 2 consecutive analyses and resumed IM in the KID study, 17 patients (9 men and 8 women) with a median age of 45 years (range, 18-63 years) entered into a second IM discontinuation after sustaining a second UMRD for a median of 25.9 months (range, 23.9-37.1 months). After a median follow-up of 17.1 months (range, 0.7-50.9 months) after second IM discontinuation, 13/17 patients (76%) and 11/17 patients (65%) lost UMRD and MMR, respectively. Among two patients who lost UMRD but not MMR, one patient showed fluctuation of BCR-ABL1 transcript under the level of 0.1% on IS for 19.5 months and another patient have shown gradually increasing BCR-ABL1 transcripts under the level of 0.1%. Eleven patients who experienced second relapse (MMR loss) after a median 2.8 months (range, 1.8-30.7 months). All the patients who lost MMR were retreated with IM for a median of 14.6 months (range, 6.6-37.6 months); eleven patients re-achieved MMR at a median of 2.8 months (range, 1.0-10.2 months) and eight patients re-achieved UMRD at 7.4 months (range, 1.8-19.5 months). When we compared the molecular kinetics after the first and second IM discontinuation, there were no differences; median time to relapse was 3.7 months vs. 2.8 months after first and second IM discontinuation, respectively, and median time to re-achieved UMRD was 7.4 months vs. 7.4 months after first and second IM resumption, respectively.

Conclusion
Our data demonstrated that a second attempt might be possible and the median time to MMR loss after second discontinuation was similar to those of the first discontinuation. But the molecular kinetics after second IM resumption needs longer follow-up with more patients. Further studies on the predictors to select patients for a trial of second TFR and novel strategies such as intermittent therapy will be warranted. 

Session topic: 8. Chronic myeloid leukemia - Clinical

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