Akademik Veri Yönetim Sistemi
9th International Congress on Leukemia Lymphoma Myeloma, İstanbul, Türkiye, 12 - 13 Mayıs 2023, cilt.1, sa.1, ss.44-45
Objectives:Chronic myeloid leukemia(CML)is a stem cell disease characterized by abnormal clonal proliferation of myeloid precursor cells and
accounts for 15% of adult leukemias.With the effective use of tyrosine
kinase inhibitors(TKIs)in the treatment of CML,survival rates of CML patients
have become closer to the general population.Although lifelong treatment
of CML patients with TKIs is recommended,this treatment approach has
been questioned and treatment-free remission(TFR)has become one of
the treatment targets in CML.For TFR,the criteria set out in the ELN2020
guidelines should be followed(Table-1).The patient’s approach to this issue
is very important for the results of TFR studies to be applied in daily life.In
our study,we aimed to evaluate the approaches of CML patients followed in
our center regarding treatment-free remission.
Methods and Materials: Patients aged 18 years and older who were followed up in ESOGU Hematology Department with a diagnosis of chronic
phase CML and who had been using a TKI for at least 3 months were included in the study.The study was a questionnaire study and the questions
asked to the patients are given in Table-2.Clinical and laboratory data were
obtained from patient files and hospital records.
Results:The mean age of 105(51 female,54 male)patients was 55.8 years.
The most recently used TKI was imatinib in 68 patients(64.8%),dasatinib in
12(11.4%),nilotinib in 20(19%)and bosutinib in 4(3.8%).31(29.5%)patients
were very satisfied with treatment,68(64.8%)were satisfied,2(1.9%)were
dissatisfied and 4(3.8%)patients were undecided about treatment satisfaction.14(13.3%)patients thought of discontinuing the treatment and
80(76.2%)patients never thought of discontinuing the treatment.71(67.6%)
patients stated that they would discontinue treatment if the doctor
deemed it appropriate,17(16.2%)would not discontinue treatment and
17(16.2%)were undecided.Among those who wanted to discontinue treatment,21(22.1%)patients stated side effects,3(3.2%)patients stated difficulty
in accessing the drug,1(1.1%)stated drug cost,2(2.1%)stated pregnancy
plan,7(7.4%)stated difficulty in use,2(2.1%)stated social security problem,
5(5.5%, 3)patients stated that they wanted to discontinue treatment due to
compliance problems,12(12.6%)patients due to multiple drug use,4(4.2%)
patients due to work environment,2(2.1%)patients due to home environment,2(2.1%)patients due to dissatisfaction with the medication and
34(35.8%)patients due to other reasons.Of those who wanted to continue
treatment,11(28.9%)stated that they would continue treatment because
of the risk of disease recurrence, 7(18.4%)because they found the drug
effective,7(18.4%)because they found the drug safe,9(23.7%)because they
were satisfied with the drug and 4(10.5%)because the doctor recommended it.The number of patients who knew that there are studies showing
that treatment can be discontinued in CML was 18(17.1%).78(32%)of the
patients stated that they would discontinue treatment if the disease did not
recur,9(3.7%)if they could use the same drug again,74(30.3%)if the doctor
recommended it,49(20.1%)if there was no risk to life,3(1.2%)in case of pregnancy planning,4(1.6%)if their family supported them and 27(11.1%)if there
were drugs that would improve their disease again.4(3.8%)patients stated
that they could stop the medication despite the risk of relapse.Frequent
follow-up visits after discontinuation affected the decision of 55(52.4%)
patients.In the case of restarting the discontinued drug,the improvement in
the disease was found to affect the decision of 77(73.3%)patients.
Conclusion:There are very few studies about the patient approach to
treatment-free remission.Patients’ willingness to discontinue the drug is as
important as the results of TKI discontinuation studies.Since most of our
patients were satisfied with treatment and never thought discontinuation it is concluded that we need time to encourage our patients for treatment
discontinuation