OncohematologyOncohematologyОнкогематология1818-83462413-4023Publishing House ABV Press36710.17650/1818-8346-2019-14-3-12-22REVIEWSОБЗОРЫTreatment-free remission in patients with chronic myeloid leukemia: literature reviewРемиссия без лечения у больных хроническим миелолейкозом: обзор литературыPetrovaA. N.ПетроваА. Н.
Russian Federation

4 Novyy Zykovskiy Proezd, Moscow 125167

Анна Николаевна Петрова

125167 Москва, Новый Зыковский проезд, 4

 

ap996@mail.ruhttps://orcid.org/0000-0001-6423-1789ChelyshevaE. Yu.ЧелышеваЕ. Ю.
Russian Federation

4 Novyy Zykovskiy Proezd, Moscow 125167

125167 Москва, Новый Зыковский проезд, 4

https://orcid.org/0000-0001-9947-2371TurkinaA. G.ТуркинаА. Г.
Russian Federation

4 Novyy Zykovskiy Proezd, Moscow 125167

125167 Москва, Новый Зыковский проезд, 4

National Research Center for Hematology, Ministry of Health of RussiaФГБУ «Национальный медицинский исследовательский центр гематологии» Минздрава России2010201914312221910201919102019https://oncohematology.abvpress.ru/ongm/article/view/367

Tyrosine kinase inhibitors have radically changed the course of chronic myeloid leukemia, significantly increasing survival and reducing the risk of disease progression. Nearly 50–70 % of patients achieve a consistently low or undetectable level of minimal residual disease – a deep molecular response. The long-term tyrosine kinase inhibitors treatment in about one-third of patients is accompanied by toxicity which impairs the quality of life. Therefore, the safe treatment discontinuation is relevant. The results of clinical trials have shown 40-60% possibility of maintaining treatment-free remission in patients with long-term deep molecular respons; however, all patients with molecular relapse regain molecular remission after the resumption of tyrosine kinase inhibitors therapy. Currently, clinical and biological factors associated with maintaining treatment-free remission are being studied. It is assumed that cessation of tyrosine kinase inhibitors therapy can improve the quality of life, but approximately 30 % of patients are reporting musculoskeletal pain – so called “withdrawal syndrome” – that begins or worsens after stopping tyrosine kinase inhibitors therapy. The mechanisms for the development of this phenomenon are currently unclear. Thus, many aspects concerning treatment-free remission require to be studied, which determines the importance of clinical trials in this area.

Терапия ингибиторами тирозинкиназ радикально изменила течение хронического миелолейкоза, значительно повысив выживаемость и снизив риск прогрессирования заболевания. У 50–70 % пациентов удается достичь низкого или неопределяемого уровня минимальной остаточной болезни – глубокого молекулярного ответа. Длительная терапия ингибиторами тирозинкиназ примерно у трети больных сопровождается развитием токсичности и снижает качество жизни, что определяет актуальность вопроса безопасного прекращения лечения. В условиях клинических исследований у больных с длительным глубоким молекулярным ответом показана возможность сохранения ремиссии без лечения примерно в 40–60 % случаев; при этом все пациенты с молекулярным рецидивом вновь достигают ремиссии после возобновления терапии ингибиторами тирозинкиназ. В настоящее время проводится поиск клинических и молекулярногенетических факторов для определения групп пациентов, имеющих наибольшую вероятность сохранения ремиссии без лечения. Предполагается, что прекращение терапии ингибиторами тирозинкиназ может улучшить качество жизни пациентов, однако в 30 % случаев наблюдается синдром отмены, проявляющийся возникновением или ухудшением ранее существующего болевого синдрома в суставах, мышцах и костях. Механизмы развития этого явления на данный момент неясны. Таким образом, многие вопросы, касающиеся ремиссии без лечения, требуют изучения, что определяет важность проведения клинических исследований в этой области.

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