BSH24-PO43 A single-site audit of treatment-free remission identification and monitoring in chronic myeloid leukaemia patients

Patients with chronic-phase chronic myeloid leukaemia (CML) with sustained deep molecular remission (DMR) may be eligible for de-escalation of their tyrosine kinase inhibitor (TKI). Approximately 40%–50% of patients stopping their TKI will maintain DMR, without medication side effects/interactions, increased cardiovascular risk (up to 8%)1 and reducing treatment cost. Strict monitoring of blood parameters during de-escalation/cessation of TKI therapy is crucial for early detection of disease recurrence.2 This single-site audit sought to assess identification of eligible patients and compliance with guidelines on monitoring of full blood count (FBC) and BCR-ABL during treatment de-escalation/treatment-free remission (TFR). Patients were identified from a local database. The eligibility guidelines were the European LeukemiaNet 2020 recommendations for CML management,3 and South West Regional Myeloproliferative Neoplasm Forum guidance on monitoring frequency during dose reduction. Of 33 eligible patients: 63% had started TFR, 12% had declined and 24% had never been approached. Analysis of monitoring compliance included 18 patients (3 excluded as TFR predated guideline). During 50% dose reduction, 83% of patients had a FBC and 61% had a BCR-ABL measured 2-monthly. After dose reduction 77.7% maintained their DMR and fully discontinued treatment, and although two of four that lost DMR had inconsistent BCR-ABL measurements, all maintained MR3. After treatment cessation 50% (of 12 patients) had both monitoring tests monthly for the first 6 months, 43% (of 7 patients) had both monitoring tests 2-monthly during months 7–12 and 66% (of 3 patients) had both monitoring tests 3-monthly at >12 months. A cost analysis found savings of up to £79 706 for the eight eligible patients not yet approached about TFR, and risk of adverse cardiac events would also be reduced. Actions: a robust system for timely identification of eligible patients is required, led by the local laboratory or a clinical or administrative team member. Patient empowerment to manage monitoring tests should be encouraged, and reducing clinic appointments to only reviewing abnormal results.

Citation

Evans S. & Frewin R. (2024). A single-site audit of treatment-free remission identification and monitoring in chronic myeloid leukaemia patients. British Journal of Haematology, 204(Supplement 1), 53-54. https://doi.org/10.1111/bjh.19398

DOI

10.1111/bjh.19398

URI

https://hdl.handle.net/20.500.14709/1241

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