Treatment free remission (TFR)

Treatment free remission (TFR) - CML - Chronic Myeloid Leukemia

Treatment free remission in CML refers of maintenance of deep molecular response without continuing TKI therapy after achieving undetectable molecular residual disease (UMRD)

Important notice: You must inform your CML doctor or a qualified doctor if you want to stop your medication. The material presented here is for information purposes only; it is not a substitute for your physician’s guidance and care.... See our disclamer

"Treatment-free remission (TFR) has recently emerged as a goal of treatment in chronic myeloid leukaemia (CML). Molecular remission is sustained in around 30% of imatinib-treated patients who stop treatment after ≥2 years with undetectable minimal residual disease (UMRD) by conventional real-time reverse transcription polymerase chain reaction. An additional 20–30% of patients will lose UMRD, but remain in stable major molecular remission off treatment. Most patients with molecular recurrence have a significant increase in BCR-ABL1 within the first 6 months off treatment, but there are also rare late relapses. As re-treatment with imatinib restores control, a trial of TFR is safe so long as careful molecular monitoring is provided to enable prompt re-treatment. The minimum eligibility criteria for a trial of TFR are not yet defined, but the available data support a MRD level of around a molecular response of 4·5 log for at least 2 years. Factors associated with a higher probability of TFR include low risk Sokal score, prior interferon treatment, longer total duration of imatinib treatment and higher numbers of natural killer cells at the time of imatinib discontinuation. Preliminary data suggest that the rate of TFR in patients treated with more potent tyrosine kinase inhibitors will probably be higher. The biology that underlies TFR is an area of active investigation."
Extract of " How I determine if and when to recommend stopping tyrosine kinase inhibitor treatment for chronic myeloid leukaemia ".

VIDEOS

Getting CML Patients Into a Deeper Treatment Response - Dr. Jerry Radich
December 20, 2019,  Patient Power

Massimo Breccia, ASH 2019: Chronic Myeloid Leukemia Patients after Discontinuation
December 18, 2019, Touch Medical Media

Treatment-Free Remission & Toxicities of Discontinuing CML Therapy
July 19, 2019, Targeted Oncology

Dr. Radich on Treatment Discontinuation in CML Off Trial
September 27, 2018, OncLive

TFR - a new treatment goal of CP-CML patients? - Dr. Delphine Rea
August 2018, iCMLf

Discontinuation of tyrosine kinase inhibitor therapy in chronic myeloid leukaemia (EURO-SKI): a prespecified interim analysis of a prospective, multicentre, non-randomised, trial
May 2018, The Lancet Oncology

Treatment-free remission in chronic myeloid leukaemia
November 2, 2017, cmladvocates

World CML Day: Treatment-free remission
September 22, 2017,  Leukaemia Care

Relapse After CML Treatment Discontinuation
March 23, 2017, OncLiveTV

Stopping second-generation TKIs in CML
February 16, 2017, Journal Blood

What is the best treatment in the next few years to achieve more treatment-free remission in CML?
July 25, 2016, VJHemOnc

Investigating cells responsible for molecular relapse in CML patients
July 29, 2016, VJHemOnc – Video Journal of Hematological Oncology

CML Stop Treatment: Dr David Ross | Rising Sun Meeting 2015
February 17, 2016, The Max Foundation

Michael Mauro Discusses Therapy-Free CML Remission
Decmber 31, 2015, OncLiveTV

The patient perspective on treatment-free remission, including support needs - Pat Elliot
May 2015, CML Horizons Barcelona

Treatment-free remission, stop trials, predictors for stopping treatment - Andreas Hochhaus
May 2015, CML Horizons Barcelona

Panel discussion: The psychology of stopping treatment
May 2015, CML Horizons Barcelona

Treatment free remission: opportunities and dangers - Alok Srivastava
March 16, 2015, iCMLf

Discontinuation of Treatment With TKIs in Chronic Myelogenous Leukemia
January 10, 2014, OncLive

Is Stopping CML Treatment a Viable Option Now?
January 17, 2013, Patient Power

Can we safely stop TKI therapies? Experience from the STOP trials - Dr. Delphine Rea
December 2012, iCMLf

TRIALS

European Stop Tyrosine Kinase Inhibitor Study (EURO-SKI)

Treatment-free Remission Accomplished With Dasatinib in Patients With CML (TRAD)

Treatment-free Remission After Achieving Sustained MR4.5 on Nilotinib (ENESTop)

Nilotinib Treatment-free Remission Study in CML (Chronic Myeloid Leukemia) Patients (ENESTFreedom)

De- Escalation and Stopping Treatment of Imatinib, Nilotinib or sprYcel in Chronic Myeloid Leukaemia (DESTINY)

Randomized Phase III Study to Assess the Effect of Longer Duration of Consolidation Treatment With Nilotinib on TFR in CP CML

SITE

Requirements for tyrosine kinase inhibitor discontinuation by Leukemia

FORUMS

Those in remission continue doing well on TKI long-term   by Asian CML Support Group
TFR Series 1-What is TFR
TFR Series 2-Risks of stopping and continuing drugs
TFR Series 3-Who Should NOT go off drugs
TFR Series 4-Monitoring in TFR by Asian CML Support Group
TFR Series 5-Case Studies (Important from Dr. Hughes article)  by Asian CML Support Group
TFR Series 6- Pros and Cons of Treatment Discontinuation by Asian CML Support Group

FORUMS ON FACEBOOK

CML Patients in TFR (Treatment Free Remission)  +++ private group on Facebook
U.S. TFR/LAST Trial Participants   +++ public group on Facebook

PUBLICATIONS

Managing chronic myeloid leukemia for treatment-free remission: a proposal from the GIMEMA CML WP
December 20, 2019, ASH Publications

Treatment-Free Remission for Chronic Myeloid Leukemia Patients
December 2018, Leukemia & Lymphoma Society

Understanding Treatment-Free Remission and How It Impacts you – Frequently Asked Questions for Patients and Advocates
September 2018, Dr. Michael J. Mauro

See also The French trial called STIM (Stop Imatinib)
See also De-escalation of treatment
See also Tyrosine Kinase Inhibitor Withdrawal Syn drome in CML Patients