{"id":730,"date":"2017-02-21T08:49:18","date_gmt":"2017-02-21T13:49:18","guid":{"rendered":"http:\/\/www.gqr-lmc-nmp.ca\/?p=730"},"modified":"2017-02-21T08:54:17","modified_gmt":"2017-02-21T13:54:17","slug":"stopping-second-generation-tkis-in-cml-2","status":"publish","type":"post","link":"https:\/\/www.gqr-lmc-nmp.ca\/system\/2017\/02\/21\/stopping-second-generation-tkis-in-cml-2\/","title":{"rendered":"Stopping second-generation TKIs in CML"},"content":{"rendered":"<p>Le Dr Pierre Laneuville a r\u00e9cemment \u00e9crit un <em>Inside Blood Commentary <\/em>accompagnant la publication suivante: &nbsp;Rea, Delphine, et al. &laquo;&nbsp;Discontinuation of dasatinib or nilotinib in chronic myeloid leukemia: interim analysis of the STOP 2G-TKI study.&nbsp;&raquo; <i>Blood<\/i> (2016): blood-2016<\/p>\n<p>&nbsp;<\/p>\n<p>Voici le r\u00e9sum\u00e9 de cette&nbsp;article&nbsp;publi\u00e9 dans le journal <em>Blood<\/em>&nbsp;<\/p>\n<p>STOP second generation (2G)-tyrosine kinase inhibitor (TKI) is a multicenter observational study designed to evaluate 2G-TKI discontinuation in chronic myeloid leukemia (CML). Patients receiving first-line or subsequent dasatinib or nilotinib who stopped therapy after at least 3 years of TKI treatment and in molecular response 4.5 (MR4.5) with undetectable <i>BCR-ABL1<\/i> transcripts for the 2 preceding years at least were eligible for inclusion. This interim analysis reports outcomes of 60 patients with a minimum follow-up of 12 months (median 47, range: 12-65). Twenty-six patients (43.3%) experienced a molecular relapse defined as the loss of a major molecular response (MMR). Relapses occurred after a median time of 4 months (range: 1-38). Cumulative incidences of molecular relapse by 12 and 48 months were 35% (95% confidence interval [CI], 24.79% to 49.41%) and 44.76% (95% CI, 33.35% to 59.91%), respectively. Treatment-free remission (TFR) rates at 12 and 48 months were 63.33% (95% CI, 51.14% to 75.53%) and 53.57% (95% CI, 40.49% to 66.65%), respectively. In univariate analysis, prior suboptimal response or TKI resistance was the only baseline factor associated with significantly worse outcome. A landmark analysis demonstrated that loss of MR4.5 3 months after stopping TKI was predictive of failure to maintain MMR later on. During the treatment-free phase, no progression toward advanced phase CML occurred, and all relapsing patients regained MMR and MR4.5 after restarting therapy. In conclusion, discontinuation of first-line or subsequent 2G-TKI yields promising TFR rates without safety concerns. Further research is encouraged to better define conditions that will offer patients the highest chance to remain free from 2G-TKI therapy.<\/p>\n<p>&nbsp;<\/p>\n<p>Voici le lien pour consulter l&rsquo;article complet : <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27932374\" target=\"_blank\">https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27932374<\/a><\/p>\n<p>Le commentaire du Dr Pierre Laneuville sur cette publication peut \u00eatre consulter via ce lien&nbsp;: <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28209750\" target=\"_blank\">https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28209750<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Le Dr Pierre Laneuville a r\u00e9cemment \u00e9crit un Inside Blood Commentary accompagnant la publication suivante: &nbsp;Rea, Delphine, et al. &laquo;&nbsp;Discontinuation\u2026<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"_links":{"self":[{"href":"https:\/\/www.gqr-lmc-nmp.ca\/system\/wp-json\/wp\/v2\/posts\/730"}],"collection":[{"href":"https:\/\/www.gqr-lmc-nmp.ca\/system\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.gqr-lmc-nmp.ca\/system\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.gqr-lmc-nmp.ca\/system\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/www.gqr-lmc-nmp.ca\/system\/wp-json\/wp\/v2\/comments?post=730"}],"version-history":[{"count":2,"href":"https:\/\/www.gqr-lmc-nmp.ca\/system\/wp-json\/wp\/v2\/posts\/730\/revisions"}],"predecessor-version":[{"id":732,"href":"https:\/\/www.gqr-lmc-nmp.ca\/system\/wp-json\/wp\/v2\/posts\/730\/revisions\/732"}],"wp:attachment":[{"href":"https:\/\/www.gqr-lmc-nmp.ca\/system\/wp-json\/wp\/v2\/media?parent=730"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.gqr-lmc-nmp.ca\/system\/wp-json\/wp\/v2\/categories?post=730"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.gqr-lmc-nmp.ca\/system\/wp-json\/wp\/v2\/tags?post=730"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}