Treatment-free remission with first- and second-generation tyrosine kinase inhibitors.
Treatment-free remission with first- and second-generation tyrosine kinase inhibitors.
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DOI：
10.1002/ajh.25342
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发表时间：
2019-03
影响因子：
12.8
通讯作者：
Lipton JH
中科院分区：
文献类型：
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作者：
Cortes J;Rea D;Lipton JH
慢性粒细胞白血病 (CML) 已成为一种慢性疾病，其慢性期可通过酪氨酸激酶抑制剂 (TKI) 治疗进行控制。对 TKI 具有最佳反应的患者已实现长期生存，无治疗缓解 (TFR) 自此成为 CML 的另一个治疗目标。在这篇综述中，我们讨论了停止治疗之前需要考虑的重要因素。此外，还检查了已发表和提出的第一代 TKI 伊马替尼的数据，以及当前评估第二代 TKI 达沙替尼和尼洛替尼 TFR 的临床试验。临床试验之外获得的结果也包括在内。由于 TKI 成功停用取决于准确的 BCR-ABL1 监测，因此还讨论了新兴技术。迄今为止获得的临床数据表明，对于许多在 TKI 治疗中达到深度分子缓解 (DMR) 的患者来说，TFR 是一个安全的治疗目标，并且，如果反应消失，患者可以期望在重新开始 TKI 后立即恢复反应。同样明显的是，要使 TFR 对于大多数患者来说成功成为现实，还有很大的改进空间。正在进行的试验数据应有助于完善决策，确定哪些患者是在安全监测的情况下尝试停用 TKI 的最佳候选者。
Chronic myeloid leukemia (CML) has become a chronic disease, for which the chronic phase is manageable with tyrosine kinase inhibitor (TKI) therapy. Patients with optimal responses to TKIs have achieved long‐term survival, and treatment‐free remission (TFR) has since become an additional treatment goal in CML. In this review, we discuss important factors to consider prior to stopping treatment. In addition, published and presented data with the first‐generation TKI imatinib, as well as current clinical trials evaluating TFR with the second‐generation TKIs dasatinib and nilotinib, are examined. Results obtained outside of clinical trials have been included as well. Because successful TKI discontinuation depends upon accurate BCR‐ABL1 monitoring, emerging technologies are also discussed. Clinical data obtained to date indicate that for many patients who achieve deep molecular response (DMR) on TKI therapy, TFR is a safe treatment goal, and, if the response is lost, patients can expect to regain their responses immediately upon reinitiation of TKI. It is also clear that there remains much room for improvement to make TFR a successful reality for most patients. Data from ongoing trials should help refine decisions as to which patients are the best candidates to attempt TKI discontinuation with safe monitoring in place.
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影响因子：
45.3
作者：
Ault, P;Kantarjian, H;Cortes, J
通讯作者：
Cortes, J
影响因子：
2.6
作者：
Benjamini O;Kantarjian H;Rios MB;Jabbour E;O'Brien S;Jain P;Cardenas-Turanzas M;Faderl S;Garcia-Manero G;Ravandi F;Borthakur G;Quintas-Cardama A;Cortes J
通讯作者：
Cortes J
影响因子：
20.3
作者：
Efficace, Fabio;Baccarani, Michele;Mandelli, Franco
通讯作者：
Mandelli, Franco
影响因子：
2.7
作者：
Breccia, Massimo;Efficace, Fabio;Alimena, Giuliana
通讯作者：
Alimena, Giuliana
在治疗慢性髓样白血病后，实验室建议对深层分子反应进行评分。
影响因子：
11.4
作者：
通讯作者：
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