Questions concerning tyrosine kinase-inhibitor therapy and transplants in chronic phase chronic myeloid leukaemia. Leukemia 2022 May;36(5):1227-1236
Date
03/27/2022Pubmed ID
35338251Pubmed Central ID
PMC9061294DOI
10.1038/s41375-022-01522-3Scopus ID
2-s2.0-85127325331 (requires institutional sign-in at Scopus site) 9 CitationsAbstract
In this provocative commentary, we consider several questions posed by the late chronic myeloid leukaemia (CML) expert Prof. Michele Baccarani, which he challenged us to address after his death. He noted only a small proportion of people with chronic phase CML receiving tyrosine kinase-inhibitor (TKI)-therapy are likely to achieve sustained therapy-free remission (TFR) and even fewer are likely to be cured. Persons most likely to fail TKItherapy can be identified at diagnosis or soon after starting TKI-therapy. These persons are likely to need lifetime TKI-therapy with attendant risks of adverse events, cost and psychological consequences. Allogeneic transplants achieve much higher rates of leukaemia-free survival compared with TKI-therapy but are associated with transplant-related adverse events including an almost 20 percent risk of transplant-related deaths within 1 year post-transplant and a compromised quality-of-life because of complications such as chronic graft-versus-host disease. Subject-, disease- and transplant-related co-variates associated with transplant outcomes are known with reasonable accuracy. Not everyone likely to fail TKI-therapy is a transplant candidate. However, in those who candidates are physicians and patients need to weigh benefits and risks of TKI-therapy versus a transplant. We suggest transplants should be more often considered in the metric when counseling people with chronic phase CML unlikely to achieve TFR with TKI-therapy. We question whether we are discounting a possible important therapy intervention; we think so.
Author List
Baccarani M, Bonifazi F, Soverini S, Castagnetti F, Gugliotta G, Saber W, Estrada-Merly N, Rosti G, Gale RPAuthor
Wael Saber MD, MS Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
HumansLeukemia, Myelogenous, Chronic, BCR-ABL Positive
Leukemia, Myeloid, Chronic-Phase
Male
Molecular Targeted Therapy
Protein Kinase Inhibitors
Protein-Tyrosine Kinases
