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Response-Related Predictors of Survival and of Treatment-Free Remission in CML

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Chronic Myeloid Leukemia

Part of the book series: Hematologic Malignancies ((HEMATOLOGIC))

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Abstract

Response to tyrosine kinase inhibitor (TKI) therapy in CML can be measured by haematological, cytogenetic and molecular criteria. Achieving haematological and cytogenetic response is still a desirable early measure of response. However measurement of the level of BCR-ABL1 transcripts in the blood by qRT-PCR, adjusted to the international scale (IS), is now the primary means of monitoring response. Achieving time-dependent molecular targets is a strong predictor of survival as well as indicating the longer-term prospects of achieving eligibility for treatment-free remission (TFR). Optimal response can be determined solely by the achievement and maintenance of time-dependent molecular response levels. Likewise, treatment failure is largely defined by a failure to achieve molecular milestones or loss of that molecular response, except in cases where treatment failure is evident by progression to advanced-phase disease. Treatment failure mandates a switch in therapy, usually to a more potent TKI, if possible. In between optimal response and treatment failure, there is a “warning category” where outcomes are generally inferior and therapeutic decisions are more complex. Recently, the importance of determining the dynamics of response, not just the BCR-ABL1 level at one specified time point, has been recognized, particularly when determining the probability of achieving sustained TFR in eligible patients.

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Authors and Affiliations

  1. Department of Genetics and Molecular Pathology, SA Pathology, Centre for Cancer Biology, Adelaide, SA, Australia

    Susan Branford & Naranie Shanmuganathan

  2. School of Pharmacy and Medical Science, University of South Australia, Adelaide, SA, Australia

    Susan Branford & Naranie Shanmuganathan

  3. School of Medicine, University of Adelaide, Adelaide, SA, Australia

    Susan Branford, Naranie Shanmuganathan & Timothy P. Hughes

  4. Precision Medicine Theme, South Australian Health & Medical Research Institute (SAHMRI), Adelaide, SA, Australia

    Susan Branford, Naranie Shanmuganathan & Timothy P. Hughes

  5. Department of Haematology, Royal Adelaide Hospital and SA Pathology, Adelaide, SA, Australia

    Naranie Shanmuganathan & Timothy P. Hughes

  6. Australasian Leukaemia and Lymphoma Group (ALLG), Melbourne, VIC, Australia

    Naranie Shanmuganathan & Timothy P. Hughes

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  1. Susan Branford
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    Rüdiger Hehlmann

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Branford, S., Shanmuganathan, N., Hughes, T.P. (2021). Response-Related Predictors of Survival and of Treatment-Free Remission in CML. In: Hehlmann, R. (eds) Chronic Myeloid Leukemia. Hematologic Malignancies. Springer, Cham. https://doi.org/10.1007/978-3-030-71913-5_15

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