ASH 2024 | Evaluating the safety of TKI discontinuation in adult patients with Ph+ ALL not undergoing alloSCT

Currently for patients with CML, chronic myeloid leukemia, treatment-free remission, discontinuing TKI is a well-established therapeutic goal. But the same is not true for Ph-positive ALL in CR1 who do not go to stem cell transplant and the duration, how long we need to continue TKI is unclear. So in this analysis, we did a retrospective chart review of patients at MD Anderson and we identified 14 patients who were Ph-positive ALL who were in complete molecular remission, CR1, and then they stopped a TKI mostly for toxicities. And we then looked at their outcomes. And three of the 14 patients subsequently had a molecular relapse. But what we’ve also noted is that all the three patients had less than a four-year duration of CMR. There were six patients who had a more than four-year duration of CMR, and none of them had a relapse so far. So I think this makes an argument and hypothesis that potentially you could consider stopping a TKI, again with a small number of patients and a retrospective analysis, maybe at least four or five years of complete molecular remission. And I would also highly recommend that if you were to do that in practice, you should also assess for the MRD, preferably by next-generation sequencing assay, to make sure there is absence of any residual B cells in the patient before you were to attempt stopping a TKI. So I think this is a new kind of a relatively new concept. And I think we need to know more data, but this provides an initial data set where I think clinicians can look and think about potentially stopping TKI if you meet a strict criteria, which we have outlined in the abstract.

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