Patient-driven discontinuation of tyrosine kinase inhibitors: single institution experience.
Patient-driven discontinuation of tyrosine kinase inhibitors: single institution experience.
复制标题
DOI：
10.3109/10428194.2013.831092
复制
发表时间：
2014-12
影响因子：
2.6
通讯作者：
Cortes J
中科院分区：
文献类型：
--
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
随着酪氨酸激酶抑制剂（TKI）治疗慢性粒细胞白血病（CML）患者结局的改善，停药对患者越来越有吸引力。我们分析了选择停止TKI治疗的患者的结局，无论他们的持续反应如何。35例慢性期CML患者在获得完全细胞遗传学缓解后停用TKI。其中51%因不良反应而停药，23%因长期CMR（>5年），9%因怀孕，17%因经济问题而停药。TKI停药后，对患者进行了中位16个月的随访。在27例（77%）因CMR停用TKI的患者中，11例（41%）在中位3.5个月后发生分子复发。在单变量分析中，我们观察到TKI停药前CMR ≥ 64个月的患者停药后12个月持续CMR和MMR上级累积比例分别为88.9% vs. 45.5%（p=0.02）和100% vs. 75%（p=0.05）。与接受标准剂量伊马替尼治疗的患者相比，接受高剂量伊马替尼或第二代TKI治疗的患者在停药后12个月的持续MMR累积比例分别为100%和72.2%（p=0.03）。在MR4.5中停用TKI的5例患者中，1例丧失细胞遗传学缓解。在MMR中停用TKI的所有3例患者均失去了细胞遗传学缓解; 1例进展至加速期。13名患者（37%）在失去应答后重新开始TKI; 11名患者的应答改善，2名患者评估为时尚早。停药可导致某些患者持续CMR，但如果患者停药时未发生CMR，则复发风险更高。
With improved outcome for patients with chronic myeloid leukemia (CML) treated with tyrosine kinase inhibitors (TKIs), treatment discontinuation has become increasingly attractive to patients. We analyzed the outcomes of patients who chose to discontinue TKI therapy regardless of their ongoing response. Thirty-five patients with chronic phase CML discontinued TKI in complete cytogenetic response. Of them 51% discontinued due to adverse effects, 23% long CMR (>5 years), 9% pregnancy, and 17% due to financial problems. After TKI discontinuation, patients were followed for a median of 16 months. Among 27 patients (77%) who discontinued TKI in CMR, 11 (41%) had molecular relapse after a median of 3.5 months. In univariate analysis we observed patients with ≥ 64 months of CMR before TKI discontinuation had superior cumulative proportions of sustained CMR and MMR at 12 months after discontinuation 88.9% vs. 45.5% (p=0.02) and 100% vs. 75% (p=0.05), respectively. Patients treated with high dose imatinib or second generation TKIs had higher cumulative proportion of sustained MMR at 12 months after discontinuation than patients treated with standard dose imatinib 100% vs. 72.2% (p=0.03), respectively. Of the 5 patients who stopped TKI in MR4.5 one lost cytogenetic response. All 3 patients who discontinued TKI in MMR lost cytogenetic response; one progressed to accelerated phase. Thirteen patients (37%) re-started TKIs after loss of response; 11 improved their response, and 2 are too early to assess. Treatment discontinuation can lead to sustained CMR in some patients, but risk of relapse is higher if patients discontinue not in CMR.
登录
查看更多内容
影响因子：
45.3
作者：
Goldman, John M.;Majhail, Navneet S.;Rizzo, J. Douglas
通讯作者：
Rizzo, J. Douglas
影响因子：
20.3
作者：
Konig, Heiko;Holyoake, Tessa L.;Bhatia, Ravi
通讯作者：
Bhatia, Ravi
影响因子：
10.3
作者：
Gambacorti-Passerini, Carlo;Antolini, Laura;Kim, Dong-Wook
通讯作者：
Kim, Dong-Wook
影响因子：
20.3
作者：
Holyoake, T;Jiang, XY;Eaves, A
通讯作者：
Eaves, A
影响因子：
20.3
作者：
Baccarani, Michele;Rosti, Gianantonio;Simonsson, Bengt
通讯作者：
Simonsson, Bengt