Outcomes of unplanned tyrosine kinase inhibitor discontinuation in patients with chronic myeloid leukemia: retrospective analysis of real-world experience in a single institution

Objectives: To explore real-world prognoses for tyrosine kinase inhibitor (TKI) discontinuation in chronic myeloid leukemia (CML) patients and the associated reasons for TKI discontinuation. Methods: We investigated, using the medical records of 85 consecutive CML patients who received TKIs between December 2001 and August 2016 at our hospital, reasons for discontinuation, duration of TKI treatment before discontinuation, molecular response (MR) status at TKI discontinuation, treatment-free remission (TFR) duration, and overall survival after TKI discontinuation. Results: TKI therapy was discontinued in 21 patients. The median treatment duration before discontinuation was 68.3 months. The response statuses at discontinuation were MR4 (n = 2), MR4.5 (n = 4), and >= MR5 (n = 15). The reasons were pleural effusion (n = 5); requests for prolonged deep molecular response (DMR) (n = 4); ischemic heart disease, anemia, and economic problems (each, n = 3); renal dysfunction (n = 2); and hyperkalemia, diarrhea, dementia, asthma, and desire to get pregnant, (each, n = 1). All patients were alive with median follow-up period of 32.1 months. TFR was maintained in 14 patients, and the 2-year TFR proportion was 66.7%. Seven patients restarted TKI therapy and achieved MR4 within median of 3 months. The duration of TKI administration before discontinuation (>= 70 months) was favored longer TFR durations. Conclusion: TKI was safely discontinued in clinical practice and yielded TFR rates similar to those observed in previous clinical trials, regardless of reason. Achievement of TFR significantly impacts patients' quality of life and should be considered in clinical practice.