Assuntos
Encéfalo/patologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Leucemia Mielogênica Crônica BCR-ABL Positiva/cirurgia , Toxoplasma/isolamento & purificação , Toxoplasmose Cerebral/líquido cefalorraquidiano , Toxoplasmose Cerebral/patologia , Condicionamento Pré-Transplante/efeitos adversos , Adulto , Antibacterianos/uso terapêutico , Antibioticoprofilaxia/métodos , Biópsia , Encéfalo/diagnóstico por imagem , Encéfalo/cirurgia , Ciclofosfamida/uso terapêutico , Febre/etiologia , Cefaleia/etiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Agonistas Mieloablativos/uso terapêutico , Reação em Cadeia da Polimerase , Toxoplasmose Cerebral/tratamento farmacológico , Toxoplasmose Cerebral/microbiologia , Condicionamento Pré-Transplante/métodos , Transplante Homólogo/efeitos adversos , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Vômito/etiologiaRESUMO
We describe herein the clinical outcomes of 16 patients with chronic myeloid leukemia in the chronic phase who stopped the administration of tyrosine kinase inhibitors (TKI) after maintaining undetectable levels of major BCR-ABL1, based on real-time quantitative polymerase chain reaction, for prolonged periods (undetectable MR for a median of 2,100 days (822-4,068). The reasons for discontinuing TKI were enrollments in a clinical trial testing discontinuation of these agents (n=9), adverse effects (n=2) or financial problems (n=5). After TKI discontinuation, patients were followed for a median of 551 days (154-2,446). A total of 8 patients (50%) experienced molecular relapse after a median of 119 days (28-171). Among them, 6 patients who lost major molecular response (MMR) were treated with imatinib (n=2) or dasatinib (n=4), while 2 patients who lost undetectable MR after discontinuing TKI (1 each had taken bostinib and imatinib) but maintained MMR were carefully monitored without re-administration of TKI. Of 6 patients who re-started TKI, 4 (67%) achieved undetectable MR but the other 2 achieved only MMR. The results of this small, retrospective study may support the current understanding of treatment discontinuation, possibly leading to a sustained deep molecular response in some patients.