An evaluation of a real-world, multi-disciplinary, treatment-free remission programme for patients with Chronic Myeloid Leukaemia

IntroductionThe management of chronic myeloid leukaemia (CML) has been revolutionized by the introduction of imatinib and other tyrosine kinase inhibitors (TKIs). Despite excellent efficacy, patient quality of life is often negatively affected by TKI side effects and there has recently been a move towards attempting to stop treatment in carefully selected patients. This approach, known as treatment-free remission (TFR), requires intensive patient monitoring, as a proportion will fail TFR and need to recommence a TKI. The aim of this study was to evaluate a multidisciplinary TFR programme in a large United Kingdom haematology centre.MethodsA retrospective cohort study was undertaken. Demographic, clinical and operational data were collected on patients attempting TFR from January 2016 to August 2024.Results37 patients attempted TFR during the study period. After a median follow-up of 37 months (range 7-106), the overall success rate was 70.3%. There was a trend towards an increased likelihood of success in patients who met international guidelines for TFR eligibility compared to those patients who did not (77% vs 55%, p = 0.18). All patients who failed TFR regained disease control after restarting medication. The majority of patient follow-up was undertaken by a specialist pharmacist or nurse, and recommended follow-up and monitoring requirements were successfully met in almost all patients.ConclusionsA multi-disciplinary model can be used to deliver a TFR programme in a real-world stetting. Clinical outcomes mirrored previous clinical trial and real-world evaluations and were particularly good in those patients who met strict stopping criteria.