Imatinib discontinuation in chronic myeloid leukaemia patients with undetectable BCR-ABL transcript level: A systematic review and a meta-analysis.
Purpose Tyrosine kinase inhibitors (TKIs) are the cornerstones of treatment for patients with chronic myeloid leukaemia (CML). In recent years, several studies were conducted to evaluate the safety of TKIs discontinuation. We performed a systematic review of the literature to determine the incidence...
| Publicado en: | European Journal of Cancer Vol. 77; pp. 48 - 57 |
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| Autores principales: | , , , , , , |
| Formato: | research systematic review Journal Article |
| Publicado: |
Pergamon Press - An Imprint of Elsevier Science
May2017
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=123866356&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 123866356 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 09598049 1VW jtl: European Journal of Cancer issn: 09598049 maglogo: N pubinfo: dt: May2017 vid: 77 pid: 2410 pub: Pergamon Press - An Imprint of Elsevier Science artinfo: ui: 123866356 123866356 123866356 10.1016/j.ejca.2017.02.028 123866356 ppf: 48 ppct: 9 formats: tig: atl: Imatinib discontinuation in chronic myeloid leukaemia patients with undetectable BCR-ABL transcript level: A systematic review and a meta-analysis. aug: au: Campiotti, Leonardo Suter, Matteo Basilio Guasti, Luigina Piazza, Rocco Gambacorti-Passerini, Carlo Grandi, Anna Maria Squizzato, Alessandro affil: Department of Medicine and Surgery, University of Insubria, Varese, Italy sug: subj: Leukemia, Myeloid, Chronic Recurrence Tyrosine Kinase Inhibitors Imatinib Therapeutic Use Proteins Chromosome Disorders Human Systematic Review Meta Analysis Medline Embase Confidence Intervals ab: Purpose Tyrosine kinase inhibitors (TKIs) are the cornerstones of treatment for patients with chronic myeloid leukaemia (CML). In recent years, several studies were conducted to evaluate the safety of TKIs discontinuation. We performed a systematic review of the literature to determine the incidence of CML relapse, to identify possible factors relapse rates and to evaluate the long-term safety in CML patients with stable undetectable BCR-ABL transcript level who discontinued TKIs. Design Studies evaluating TKIs discontinuation in CML patients with undetectable BCR-ABL transcript level were identified by electronic search of MEDLINE and EMBASE database until May 2015. Weighted mean proportion and 95% confidence intervals (CIs) of CML relapse was calculated using a fixed-effects and a random-effects model. Statistical heterogeneity was evaluated using the I 2 statistic. Results Fifteen cohort studies, for a total of 509 patients, were included. Nine studies were at low-risk of bias. All 15 studies included only patients on imatinib. Overall weighted mean molecular relapse rate of CML was 51% (95% CI 44–58%; I 2 = 55). Weighted mean molecular relapse rate at 6-month follow-up was 41% (95% CI 32–51%; I 2 = 78). Eighty percent of molecular relapses occurred in the first 6 months. All 509 patients were alive at 2-year follow-up and only one patient (0.8%, 95% CI 0.2–1.8%; I 2 = 0) has progressed to a blastic crisis. Conclusions Our findings suggest that imatinib discontinuation is feasible for the majority of CML patients with stable undetectable BCR-ABL transcript level. Approximately 50% of patients remain therapy-free after imatinib discontinuation. Restarting TKIs therapy was followed by a very high rate of molecular response, with no deaths 2 years after discontinuation. pubtype: Academic Journal doctype: meta analysis research systematic review Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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