Further augmentation of molecular responses with dasatinib therapy in chronic myeloid leukemia patients who gained major molecular response under imatinib
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With the advent of imatinib—the first tyrosine kinase inhibitor (TKI) used to treat chronic myeloid leukemia (CML)—managing patients with CML in the chronic phase (CML-CP) has changed dramatically. Second-generation TKIs (2GTKIs) are more potent than imatinib and can be a better option. Nilotinib and dasatinib were superior to imatinib regarding speed and depth of responses, with no significant benefit in long-term outcomes, including progression-free and overall survivals (PFS and OS) over imatinib in the frontline setting .
Achieving and maintaining deep molecular response (DMR) may give patients an opportunity to temporarily discontinue TKI treatment, and treatment-free remission (TFR) was investigated in several studies, first with imatinib and then with 2GTKIs (nilotinib or dasatinib) . Since the probability of gaining DMR is higher with 2GTKIs than with imatinib, it seems wiser to use these more potent TKIs in patients who wish to discontinue therapy.
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Conflict of interest
AEE has received honoraria from Novartis and Bristol-Myers Squibb.
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