Minimal residual disease and discontinuation of therapy in chronic myeloid leukemia: can we aim at a cure?

Junia V. Melo, David M. Ross

Research output: Contribution to journalReview article

27 Citations (Scopus)

Abstract

Patients with chronic myeloid leukemia (CML) who have achieved a complete molecular response (CMR) defined by no detectable BCR-ABL mRNA on imatinib (IM) treatment often ask whether it is necessary for treatment to continue. We now know that approximately 40% of patients with a stable CMR for at least 2 years are able to stop IM treatment and remain in molecular remission for at least 2 years. This exciting observation has raised hopes that many patients can be cured of CML without the need for transplantation and its attendant risks. One might argue that for many patients maintenance therapy with IM or an alternative kinase inhibitor is so well tolerated that there is no imperative to stop treatment; however, chronic medical therapy may be associated with impaired quality of life and reduced compliance. Inferences about the biology of CML in patients responding to kinase inhibitors can be drawn from clinical experience, molecular monitoring data, and experimental observations. We summarize this information herein, and propose 3 possible pathways to "cure" of CML by kinase inhibitors: stem-cell depletion, stem-cell exhaustion, and immunological control.

Original languageEnglish
Pages (from-to)136-142
Number of pages7
JournalHematology / the Education Program of the American Society of Hematology. American Society of Hematology. Education Program
Volume2011
DOIs
Publication statusPublished - 2011
Externally publishedYes

ASJC Scopus subject areas

  • Hematology

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