Loss of complete cytogenetic response after nilotinib discontinuation

Abstract

The achievement of treatment-free remission (TFR) became recently a new, important goal of chronic myelogenous leukemia (CML) therapy. The strategy to achieve durable, deep molecular response, and, subsequently, to discontinue tyrosine kinase inhibitor (TKI) is particularly attractive for younger patients, and for those, who experience long-lasting side effects that reduce substantially the quality of life. The results of many clinical trials suggest that approximately 50% of patients can achieve durable TFR. In the remaining patients, loss of major molecular response (and less frequently complete cytogenetic response [CCyR]) is the cause of treatment reintroduction. Discontinuation of TKI is considered a safe procedure. No disease progressions or deaths caused by treatment discontinuation were noted so far. Here, we present a case of a patient who lost a CCyR after discontinuation of nilotinib. The reintroduction of nilotinib resulted in the rapid achievement of CCyR and DMR (MR4).