Nilotinib can now be given to children aged 1 year or older with Philadelphia chromosome-positive CML in the chronic phase , either for a new diagnosis or following the development of intolerance or resistance to previous tyrosine kinase inhibitors (TKIs).

By Lynda Williams medwireNews is an independent medical news service provided by Springer Healthcare. © 2018 Springer Healthcare part of the Springer Nature group See also:          CML treatment-free remission possible with nilotinib           ENESTop findings add support to second-line nilotinib

The ENESTfreedom study of patients who stopped first-line nilotinib after achieving a sustained deep molecular response has shown that around half of chronic myeloid leukemia patients continue in remission.

medwireNews: Over half of chronic myeloid leukaemia (CML–CP) patients in the chronic phase who discontinue second-line nilotinib therapy after achieving a sustained deep molecular response (MR) remain ...

Over half of chronic myeloid leukaemia patients in the chronic phase who discontinue second-line nilotinib therapy after achieving a sustained deep molecular response (MR) remain in treatment-free remission 48 weeks later, suggests research presented at the European Hematology Association congress in Copenhagen, Denmark.

However, the researchers point out that this rate is higher than that previously reported for nilotinib (7%) and sunitinib (16%).

Several other TKIs are currently FDA-approved for the therapy of patients with CML: nilotinib [8], dasatinib [9], bosutinib [10] and ponatinib [11].

Tyrosine kinase inhibitor (TKI) treatment of chronic myeloid leukemia (CML) can result in prolonged and deep responses in many patients. In such cases, can TKIs be safely discontinued to avoid adverse side effects and costs? Etab Atallah (Medical College of Wisconsin, USA) discusses the current issues surrounding TKI discontinuation in CML.

Of the 126 patients who achieved MR 4.5 , TFR began after a median of 53.0 months of treatment with nilotinib; 51 patients restarted nilotinib following loss of MMR or MR 4 .

Just one (7%) patient switched to nilotinib after losing CCyR at 12 months.

Specifically, sCD62L levels were high at diagnosis and decreased during nilotinib therapy as CD62L T-cell expression increased. 

The patients were asked to halve their dose of imatinib, nilotinib or dasatinib, with a plan to discontinue treatment if remission was maintained after 13 months.

Among 30 CML patients who had received a tyrosine kinase inhibitor for at least 1 month – nilotinib in five patients, imatinib in seven, and dasatinib in 18 – 10 had a positive fecal occult blood test.

In addition, dose escalation studies are ongoing for a once daily ABL001 dose and ABL001 given alongside nilotinib, imatinib or dasatinib, as well as for twice daily dosing in higher-risk patients with blast phase CML or Philadelphia chromosome-positive acute lymphoblastic leukemia (ALL), Hughes explained.

Following imatinib treatment failure or disease progression, imatinib dose was escalated in 20.8% of the branded and 17.2% of the generic groups, with 2.1% versus 4.5% moving onto nilotinib, 0.9% versus 5.1% to dasatinib, and 0.9% versus 2.2% to hydroxyurea.