Response-Related Predictors of Survival and of Treatment-Free Remission in CML

Susan Branford, Naranie Shanmuganathan, Timothy P. Hughes

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

Abstract

Response to tyrosine kinase inhibitor (TKI) therapy in CML can be measured by haematological, cytogenetic and molecular criteria. Achieving haematological and cytogenetic response is still a desirable early measure of response. However measurement of the level of BCR-ABL1 transcripts in the blood by qRT-PCR, adjusted to the international scale (IS), is now the primary means of monitoring response. Achieving time-dependent molecular targets is a strong predictor of survival as well as indicating the longer-term prospects of achieving eligibility for treatment-free remission (TFR). Optimal response can be determined solely by the achievement and maintenance of time-dependent molecular response levels. Likewise, treatment failure is largely defined by a failure to achieve molecular milestones or loss of that molecular response, except in cases where treatment failure is evident by progression to advanced-phase disease. Treatment failure mandates a switch in therapy, usually to a more potent TKI, if possible. In between optimal response and treatment failure, there is a “warning category” where outcomes are generally inferior and therapeutic decisions are more complex. Recently, the importance of determining the dynamics of response, not just the BCR-ABL1 level at one specified time point, has been recognized, particularly when determining the probability of achieving sustained TFR in eligible patients.

Original languageEnglish
Title of host publicationHematologic Malignancies
PublisherSpringer Science and Business Media Deutschland GmbH
Pages245-264
Number of pages20
DOIs
Publication statusPublished or Issued - 2021

Publication series

NameHematologic Malignancies
ISSN (Print)2197-9766
ISSN (Electronic)2197-9774

Keywords

  • Deep molecular response
  • Early molecular response
  • Major molecular remission
  • Molecular monitoring
  • qRT-PCR
  • Treatment-free remission

ASJC Scopus subject areas

  • Hematology
  • Oncology

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