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In patients who relapse during a treatment-free period after achieving remission on prior 1st/2nd generation TKI, what factors should be taken into consideration when restarting treatment?

Will you use asciminib at that point instead of restarting prior TKI (even if well tolerated)? Does mutation testing play a role in selecting the next agent after treatment-free remission?
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How would you manage a patient with relapsed CML, after achieving remission on prior 1st/2nd gen TKI?

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3 Answers
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Medical Oncology · Georgia Cancer Center at Augusta University
Answered on

I would usually restart therapy in patients who lose MMR after a failed TFR attempt. I would usually use the same TKI they were using before stopping, unless part of the reason for stopping was toxicity, in which case I would consider an alternative TKI that may have a lower probability of having a ...

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Hematology · Memorial Sloan Kettering Cancer Center
Answered on

While an important question to study, we do not yet know if asciminib would yield better outcomes, perhaps focusing on tolerability and/or the ability to successfully attempt a subsequent treatment-free remission, if patients were switched to it after relapsing during a treatment-free remission atte...

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Medical Oncology · Mary Lanning Healthcare Morrison Cancer Center/University of Nebraska Medical Center Adjunct Faculty
Answered on

Regardless of whether the same or a different TKI is used, most patients who relapse after their original TKI discontinuation rapidly regain major molecular response or deep molecular response upon restarting therapy.

Patient-specific factors such as prior TKI tolerability, comorbidities, patient pre...

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