Modeling the safe minimum frequency of molecular monitoring for CML patients attempting treatment-free remission

Naranie Shanmuganathan, Jodi A. Braley, Agnes S.M. Yong, Devendra K. Hiwase, David T. Yeung, David M. Ross, Timothy P. Hughes, Susan Branford

Research output: Contribution to journalLetterpeer-review

15 Citations (Scopus)


With the increasing adoption of treatment-free remission (TFR) as a goal for patients with chronic myeloid leukemia (CML), rigorous molecular monitoring has been recommended to ensure timely tyrosine kinase inhibitor (TKI) recommencement in the event of molecular relapse. The National Comprehensive Cancer Network (NCCN) has now incorporated TFR into its most recent guidelines, recommending monthly quantitative polymerase chain reaction monitoring of BCR-ABL1 for the first 12 months following TKI discontinuation.1 Molecular relapse, the trigger to restarting TKI, is currently defined as loss of major molecular response2 (MMR; BCR-ABL1 ≤ 0.1% International Scale), and predominantly occurs in the first 6 months following TKI cessation.3,4 Delay in detection of molecular relapse may place patients at unnecessary risk of adverse outcomes, such as loss of complete hematological response. At a minimum, it delays the reachievement of MMR and deep molecular response (MR4; BCR-ABL1 ≤ 0.01% or MR4.5; BCR-ABL1 ≤ 0.0032%). Conversely, an overly rigorous monitoring schedule imposes unnecessary costs associated with a TFR attempt, adding to logistical difficulties experienced by some patients in accessing highly sensitive, standardized BCR-ABL1 testing,5 and may prevent some patients from stopping therapy. This is especially important in countries where funding of molecular testing is limited, and patients may be required to pay for additional tests.
Original languageEnglish
Pages (from-to)85-89
Number of pages5
Issue number1
Publication statusPublished - 4 Jul 2019


  • Treatment-free remission
  • Chronic myeloid leukemia
  • Molecular relapse


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