Treatment-Free Remission in Chronic Myeloid Leukemia

Over the last decade, a medically supervised trial of tyrosine kinase inhibitor (TKI) discontinuation has become an important option for patients with chronic phase chronic myeloid leukaemia (CML). A successful attempt, termed ‘treatment-free remission’ (TFR), has enabled selected patients to remain off TKI therapy long-term and has now been integrated into international treatment guidelines. Approximately 40–65% of chronic phase CML patients who cease TKI while in sustained deep molecular response will be able to remain off TKI in major molecular response 12 months after drug discontinuation. Consequently, understanding the nuances and complexities of TFR is vital for physicians offering and guiding their patients through a TFR attempt. Within this chapter, we present the data underpinning the TFR strategy, including appropriate patient selection and logistics of molecular monitoring. The potential risks and benefits of a TFR attempt will also be discussed, as well as emerging predictors of a successful TFR attempt which may guide future practice.