Treatment Free Remission in Chronic Myeloid Leukemia- A Practical Option

Abstract

Chronic myeloid leukemia (CML) is a type of blood malignancy. Unlike some other diseases and cancers, the treatment for CML typically spans many years. Patients achieving and sustaining a deep molecular response may be candidates for treatment stoppage. This concept also known as treatment free remission (TFR) is a new concept in CML management and of late has become a major goal. TFR has also taken the center stage owing to its implications in reducing health and financial burden being imposed by the disease. Numerous clinical trials have made an attempt to study as to which patients are the best candidates for treatment free remission and what percentage of such patients either stay in remission stage or face relapse. Findings of the trials suggest around 45-60% of patients being able to achieve TFR whereas the relapse mostly occurred in first six months of treatment stoppage. Nevertheless, almost all patients who were re-initiated on Tyrosine kinase inhibitors (TKIs) showed molecular response. Certain clinical and molecular biomarkers are thought to be linked to increase probability of TFR. In this review we attempt to discuss both clinical and molecular markers associated with TFR in CML.