PB2267 PERCEPTION OF THE DISCONTINUATION OF TYROSINE‐KINASE INHIBITOR TREATMENT IN PATIENTS WITH CHRONIC MYELOID LEUKEMIA OF THE ANDALUSIAN GROUP OF CML (GALMC)
Authors: Fernandez E. L.ó.pez , Puerta J. M. Puerta , Badiola J. , Marfil M.N. P.é.rez , Chaves C. Ferrer , Pérez M. J. García , Molina C. Avellaneda , Arance M. Anguita , Garrido P. López , Fernández S. De Linares 
Published: June 2019

Background:

The encouraging results of the first clinical trials evaluating the discontinuation of tyrosine‐kinase inhibitor (TKI) treatment in patients with CML have brought into question the therapeutic approach for this hemopathy. Many patients who nowadays cannot benefit from participation in discontinuation studies express a true desire to discontinue their chronic treatment.

Aims:

To know the opinion of patients about the possibility of treatment free remission (TFR), and to analyze other related factors such as the relationship between the patient and the disease as well as the associated treatment. Also, to identify the concerns and difficulties perceived by the patients.

Methods:

We have surveyed patients with CML and TKI treatment from 5 hospitals within the Andalusian Group of LMC (GALMC) registry between 2016 and 2018. A specific survey designed consisting of multiple‐choice items or Lickert‐type scales (0 to 5) aimed at measuring the perception of the impact of the disease in the daily lives of the patients. Treatment adherence and willingness to treatment discontinuation were also explored.

Results:

We have included 114 patients with following characteristics: median age 55 years (26‐87). 72 men (63%) and 42 women (37%). Current treatment: imatinib (61%), nilotinib (26%), dasatinib (26%) and ponatinib (1%). First‐line treatment: imatinib (44.34%) (median follow‐up 93 months), nilotinib (13%) (67 months) and dasatinib 10.4% (54 months). Second line treatment: imatinib (7%), dasatinib (10.4%), nilotinib (8%) and ponatinib (0.8%). Third line treatment: nilotinib (1.8%) and dasatinib (1.8%). Fourth line treatment: imatinib (1.8%).

The patients reported a very good coexistence with the disease (ME = 4.07, SD = 0.98), which is supported by a low frequency of adverse effects (37.4% very occasionally and 30% never). The main concern about the disease is the possibility of progression (57.4%) and in terms of chronic treatment, the unknown possible adverse events in the future (30%).

The patients showed very good adherence to the treatment (ME = 4.71, SD = 0.78) indicating that 72% of the patients never forget to take the medication. This adherence was reported to be further consolidated by the practitioner at consultation (73%). Also, 74% of the patients consult their problems directly with the doctor instead of other sources.

Patients reported that the information about the discontinuation was transmitted by the medical team in 78.3% of cases. 74.8% of patients of the study responded “YES” to the possibility of TKI discontinuation, always controlled by their hematologist.

However in those patients who did not learn about treatment discontinuation from their doctors or do not have information about TFR, only a 22% said they would discontinue their treatment.

With regard to the benefit of the treatment discontinuation, the feeling of being cured (44.7%) together with the overall improvement of the quality of life (19.5%) would be the main advantages expressed by our patients.

Summary/Conclusion:

Patients with CML generally present a good coexistence with the disease and its treatment despite the fear of the progression and unknown secondary events.

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The low frequency of perceived adverse effects, the possibility of consulting any problem and the promotion of adherence by professionals seem to be key factors for a better adaption to the consequences of suffering a chronic disease and life‐long treatment. Despite this, a large majority of our patients (74.8%) expressed their desire to interrupt their treatment in order to achieve the cure of the disease.