Eligibility for treatment-free remission among chronic myeloid leukemia patients in Iraqi Kurdistan region

BACKGROUND:The advent of tyrosine kinase inhibitors (TKIs) has significantly improved the survival rates of patients with chronic myeloid leukemia (CML) patients. The frequent side effects of TKIs have necessitated the need for a new approach. Treatment-free remission (TFR) has become a key goal in CML management, allowing eligible patients who meet specific criteria to safely discontinue TKI therapy.OBJECTIVES:The objectives of this study were to identify CML patients on TKI therapy who are eligible for TFR, compare the clinical and hematological parameters among eligible and ineligible patients, and explore the reasons for patients' willingness or reluctance to pursue TFR.PATIENTS AND METHODS:This retrospective study reviewed 129 accessible medical records of CML patients in three hemato-oncology centers in Iraqi Kurdistan between 2008 and 2024. Eligibility for TFR was assessed based on local criteria aligned with international guidelines, and eligible patients were compared to ineligible ones.RESULTS:Files of 129 CML patients on TKI therapy were reviewed. Their median age at diagnosis was 46 years. Only 8.5% of the patients were eligible for TFR. Ineligibility was primarily due to insufficient TKI treatment (41.6%), inadequate deep molecular response (17.5%), and lack of regular molecular follow-up (40.6%). While patients expressed their desire to discontinue TKI to avoid side effects and reduce compliance, reluctance stemmed from fear of relapse and the unavailability of newer generation TKIs in case of the development of resistant mutations.CONCLUSIONS:A minority of CML patients in our region were eligible for TFR. Ineligibility for TFR was mainly due to insufficient TKI therapy and irregular molecular monitoring.