Dr. Schiffer on Factors to Consider for TKI Discontinuation in CML

Charles Schiffer, MD, professor of Oncology and Medicine, Wayne State University, oncologist/hematologist, Barbara Ann Karmanos Cancer Institute, discusses factors to consider for TKI discontinuation in chronic myeloid leukemia (CML).

Patients with CML who have had consecutively low or negative transcript levels for a number of years may be eligible to discontinue treatment with a TKI, says Schiffer. Patients who discontinue treatment are monitored closely via blood tests rather than bone marrow tests, Schiffer says.

Utilizing blood tests, a patient’s polymerase chain reaction level can be monitored every month for the first 6 to 8 months after stopping treatment, says Schiffer. From then on, testing may decrease to every 2 or 3 months.

Some patients who discontinue treatment may develop TKI withdrawal syndrome, which manifests mainly as musculoskeletal aches, Schiffer says. Most often, this syndrome is managed with nonsteroidal anti-inflammatory drugs, but symptoms could worsen or become persistent.

Notably, nearly all patients who relapse after stopping a TKI respond when therapy is reinitiated, as long as they’re appropriately monitored, concludes Schiffer.