NCCN Guidelines Updates: Discontinuing TKI Therapy in the Treatment of Chronic Myeloid Leukemia

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The NCCN Guidelines for Chronic Myeloid Leukemia (CML) criteria for discontinuation of tyrosine kinase inhibitor (TKI) therapy have not seen significant updates in the past year, but the current guidelines reinforce the safety of treatment discontinuation in appropriate and consenting patients with CML in the chronic phase who have achieved and maintained a deep molecular response. According to Dr. Neil Shah, who presented the current data, some clinicians are still unaware that treatment discontinuation is an option. Patients who wish to stop TKI therapy should consult with a CML specialty center to confirm that discontinuation is safe and appropriate; they also should be counseled on all potential benefits and risks of stopping therapy, including TKI withdrawal syndrome. In patients with CML who experience relapse after discontinuing TKI therapy, a second TKI discontinuation can be successful among those who regained a deep molecular response after TKI rechallenge, although experience to date with second discontinuation attempts is very limited. Second-generation TKIs have also demonstrated improvement in rates of deep molecular remission, making treatment discontinuation possible for a larger proportion of patients.

Correspondence: Neil P. Shah, MD, PhD, Division of Hematology and Oncology, UCSF Helen Diller Family Comprehensive Cancer Center, 505 Parnassus Avenue, Suite M1286, Box 1270, San Francisco, CA 94143. Email: neil.shah@ucsf.edu
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