Feasibility of the imatinib stop study in the Japanese clinical setting: delightedly overcome CML expert stop TKI trial (DOMEST Trial)

Shin Fujisawa, Yasunori Ueda, Kensuke Usuki, Hajime Kobayashi, Eisei Kondo, Noriko Doki, Takafumi Nakao, Yoshinobu Kanda, Nobuharu Kosugi, Hiroshi Kosugi, Takashi Kumagai, Hiroshi Harada, Masato Shikami, Yasuhiro Maeda, Toru Sakura, Koiti Inokuchi, Akio Saito, Yuichiro Nawa, Masahiro Ogasawara, Junji NishidaTakeshi Kondo, Chikashi Yoshida, Hiroyuki Kuroda, Yoko Tabe, Yoshinobu Maeda, Kenji Imajo, Kensuke Kojima, Satoshi Morita, Sho Komukai, Atsushi Kawaguchi, Junichi Sakamoto, Shinya Kimura

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Abstract

Background: Treatment-free remission (TFR), the ability to maintain a molecular response (MR), occurs in approximately 50% of patients with chronic myelogenous leukemia (CML) treated with tyrosine kinase inhibitors (TKIs). Methods: A multicenter phase 2 trial (Delightedly Overcome CML Expert Stop TKI Trial: DOMEST Trial) was conducted to test the safety and efficacy of discontinuing imatinib. Patients with CML with a sustained MR of 4.0 or MR4.0-equivalent for at least 2 years and confirmed MR4.0 at the beginning of the study were enrolled. In the TFR phase, the international scale (IS) was regularly monitored by IS-PCR testing. Molecular recurrence was defined as the loss of MR4.0. Recurrent patients were immediately treated with dasatinib or other TKIs including imatinib. Results: Of 110 enrolled patients, 99 were evaluable. The median time from diagnosis to discontinuation of imatinib was 103 months, and the median duration of imatinib therapy was 100 months. Molecular recurrence-free survival rates were 69.6%, 68.6% and 64.3% at 6, 12, and 24 months, respectively. After discontinuation of imatinib therapy, 26 patients showed molecular recurrence, and 25 re-achieved deep MR after dasatinib treatment. Molecular response MR4.0 was achieved in 23 patients within 6 months and 25 patients within 12 months. Multivariate analysis revealed that a longer time from diagnosis to discontinuation of imatinib therapy (p = 0.0002) and long duration of imatinib therapy (p = 0.0029) predicted a favorable prognosis. Conclusions: This DOMEST Trial showed the feasibility of TKI discontinuation in a Japanese clinical setting.

Original languageEnglish
Pages (from-to)445-453
Number of pages9
JournalInternational Journal of Clinical Oncology
Volume24
Issue number4
DOIs
Publication statusPublished - Apr 15 2019

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Keywords

  • Chronic myelogenous leukemia
  • Deep molecular response
  • Imatinib
  • Molecular recurrence-free survival
  • Treatment-free remission

ASJC Scopus subject areas

  • Surgery
  • Hematology
  • Oncology

Cite this

Fujisawa, S., Ueda, Y., Usuki, K., Kobayashi, H., Kondo, E., Doki, N., Nakao, T., Kanda, Y., Kosugi, N., Kosugi, H., Kumagai, T., Harada, H., Shikami, M., Maeda, Y., Sakura, T., Inokuchi, K., Saito, A., Nawa, Y., Ogasawara, M., ... Kimura, S. (2019). Feasibility of the imatinib stop study in the Japanese clinical setting: delightedly overcome CML expert stop TKI trial (DOMEST Trial). International Journal of Clinical Oncology, 24(4), 445-453. https://doi.org/10.1007/s10147-018-1368-2