Redefining treatment-free remission criteria in chronic myeloid leukemia in India

Chronic myeloid leukemia (CML) is the most common hematological malignancy in India and its treatment has been revolutionized by BCR-ABL tyrosine kinase inhibitors. Even though it is considered non-curable, with long-term treatment, a selected set of patients may be eligible for stoppage of treatment and continued observation (treatment-free remission [TFR]) according to the current guidelines. All these guidelines are from other countries and at present, Indian oncologists and patients have to follow these guidelines to implement TFR protocols. The commonly used international guidelines also have differences in the methods of implementation of TFR in CML. There are very few articles from India with data on TFR in CML and we need to gather more data if we are to formulate our own criteria and guidelines. Indian patients have a unique set of problems with the disease biology and its treatment. The potential issues with implementing TFR among Indian patients have to be identified and solved successfully and these have to be taken into account before creating such criteria for India. The review aims to summarize the current criteria in place for TFR in CML, to discuss the issues in implementing the criteria directly in India, to define the needs of India CML patients, and to recommend the considerations to be taken into account while redefining such a criteria for Indian patients.