PMID- 33535564
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20210210
IS  - 2077-0383 (Print)
IS  - 2077-0383 (Electronic)
IS  - 2077-0383 (Linking)
VI  - 10
IP  - 3
DP  - 2021 Feb 1
TI  - Dose Optimization of Tyrosine Kinase Inhibitors in Chronic Myeloid Leukemia: A 
      New Therapeutic Challenge.
LID - 10.3390/jcm10030515 [doi]
LID - 515
AB  - The chronic myeloid leukemia (CML) therapeutic landscape has dramatically changed 
      with tyrosine kinase inhibitor (TKI) development, which allows a near-normal life 
      expectancy. However, long-term TKI exposure has been associated with persistent 
      adverse events (AEs) which negatively impact on quality of life (QoL) and have 
      the potential to cause significant morbidity and mortality. In clinical practice, 
      TKI dose reduction is usually considered to reduce AEs and improve QoL, but dose 
      optimization could have also another aim, i.e., the achievement and maintenance 
      of cytogenetic and molecular responses. While therapy cessation appeared as a 
      safe option for about half of the patients achieving an optimal response, no 
      systematic assessment of long-term TKI dose de-escalation has been made. The 
      present review is focused on the most recent evidences for TKIs dose 
      modifications in CML clinical studies and in the real-life setting. It will 
      consider TKI dose modifications in newly diagnosed patients, dose reduction for 
      AEs, or in deep molecular response, either as a prelude to treatment-free 
      remission (TFR) or as continuous maintenance therapy in those patients not 
      wishing to attempt TFR. In addition, it will focus on patients not achieving a 
      molecular response deep enough to go to TFR, and for whom dose reduction could be 
      an option to avoid AEs.
FAU - Iurlo, Alessandra
AU  - Iurlo A
AUID- ORCID: 0000-0002-4401-0812
AD  - Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 
      20122 Milan, Italy.
FAU - Cattaneo, Daniele
AU  - Cattaneo D
AD  - Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 
      20122 Milan, Italy.
FAU - Bucelli, Cristina
AU  - Bucelli C
AD  - Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 
      20122 Milan, Italy.
FAU - Breccia, Massimo
AU  - Breccia M
AD  - Hematology, Department of Translational and Precision Medicine, Sapienza 
      University, Policlinico Umberto 1, 00161 Rome, Italy.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20210201
PL  - Switzerland
TA  - J Clin Med
JT  - Journal of clinical medicine
JID - 101606588
PMC - PMC7867069
OTO - NOTNLM
OT  - bosutinib
OT  - chronic myeloid leukemia
OT  - dasatinib
OT  - imatinib
OT  - nilotinib
OT  - ponatinib
OT  - prognosis
OT  - treatment de-escalation
OT  - treatment-free remission
OT  - tyrosine kinase inhibitor
COIS- A.I.: Novartis, Pfizer, Incyte: Speaker Honoraria; M.B.: Novartis, Pfizer, 
      Incyte, Celgene: Advisory Committees and Consultancy.
EDAT- 2021/02/05 06:00
MHDA- 2021/02/05 06:01
PMCR- 2021/02/01
CRDT- 2021/02/04 01:01
PHST- 2021/01/08 00:00 [received]
PHST- 2021/01/26 00:00 [revised]
PHST- 2021/01/28 00:00 [accepted]
PHST- 2021/02/04 01:01 [entrez]
PHST- 2021/02/05 06:00 [pubmed]
PHST- 2021/02/05 06:01 [medline]
PHST- 2021/02/01 00:00 [pmc-release]
AID - jcm10030515 [pii]
AID - jcm-10-00515 [pii]
AID - 10.3390/jcm10030515 [doi]
PST - epublish
SO  - J Clin Med. 2021 Feb 1;10(3):515. doi: 10.3390/jcm10030515.