L'arrêt des thérapies ITK est-il possible?

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Discontinuation of Imatinib Therapy After Achieving a Molecular Response in Chronic Myeloid Leukemia Patients
ASH2009 -décembre 2009
Francois-Xavier Mahon, Delphine Rea, MD, PhD, Francois Guilhot, MD, Francoise Huguet, Franck Emmanuel Nicolini, MD, PhD, Laurence Legros, Aude Charbonnier, Agnes Guerci, Bruno R. Varet, MD, Gabriel Etienne, MD, Emilie Aton, Josy Reiffers, MD and Philippe Rousselot, MD, PhD
Université Victor Segalen, Bordeaux, France
Hôpital Saint Louis, Paris, France
Hôpital Jean Bernard, Poitiers, France
Dept. Hematology, Hopital de Purpan, Toulouse, France
Hematology, Hopital Edouard Herriot, Lyon, France
CHU de Nice, Nice, France
Institut Paoli Calmette, Marseille, France
CHU Brabois, Nancy, France
Hematology Dept., Paris Descartes Univ. Necker Hospital, Paris, France
Service d'Hématologie, Institut Bergonie, Bordeaux, France
Hôpital Haut Leveque - Pessac, Bordeaux, France
Université Victor Segalen Bordeaux 2, ARMA, Bordeaux, Cedex, France
Hôpital André Mignot, Versailles, France
'Conclusions - We have confirmed that CMR can be sustained after discontinuation of imatinib with a long follow-up, particularly in male patients and in pts with cytotoxic NK cells in their peripheral blood. Using stringent criteria, it is possible to stop treatment in patients with sustained CMR, even in those treated with IM as a single agent.'
http://ash.confex.com/ash/2009/webprogr ... 18033.html

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Discontinuation of imatinib therapy after achieving a molecular response
Blood Journal, 1 October 2004, Vol. 104, No. 7, pp. 2204-2205.
'These 3 patients illustrate the need for continued therapy with imatinib after achieving molecular remission. Despite undetectable BCR-ABL levels on imatinib that were sustained for up to 21 months, relapses rapidly occurred in all 3 patients'
Extrait de http://bloodjournal.hematologylibrary.o ... 104/7/2204

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Imatinib mesylate discontinuation in patients with chronic myelogenous leukemia in complete molecular remission for more than 2 years , Blood, 1 January 2007, Vol. 109, No. 1, pp. 58-60.
Philippe Rousselot, Francoise Huguet, Delphine Rea, Laurence Legros, Jean Michel Cayuela, Odile Maarek, Odile Blanchet, Gerald Marit, Eliane Gluckman, Josy Reiffers, Martine Gardembas, François-Xavier Mahon, The Intergroupe Français des Leucémies Myéloïdes Chronique (FILMC)
Fédération d'hématologie et Centre d'Investigation Clinique, Hôpital Saint-Louis, Paris, France;
Service d'Hématologie et d'Oncologie, Hôpital Mignot, Versailles, France;
Service d'Hématologie, Hôpital de Purpan, Toulouse, France;
Service d'hématologie, Hôpital Larchet, Nice, France;
Laboratoire Central d'Hématologie, Institut National de la Santé et de la Recherche Médicale (INSERM) Unité (U) 728, Hôpital Saint-Louis, Paris, France;
Laboratoire d'hématologie, Centre Hospitalo-Universitaire (CHU) d'Angers, France;
Service des Maladies du Sang, CHU du Haut Lévèque, Pessac, France;
Institut Bergonié, Bordeaux, France;
Service d'Hématologie, CHU d'Angers, France;
Laboratoire Hématopoïèse normale et leucemique, Université Victor Ségalen Bordeaux 2, INSERM E217, France
In the present study, we address the issue of the discontinuation of imatinib mesylate (Gleevec) in chronic myelogenous leukemia with undetectable residual disease for more than 2 years. Twelve patients were included. The median duration of real-time quantitative–polymerase chain reaction (RTQ-PCR) negativity and imatinib therapy were, respectively, 32 months (range, 24-46 months) and 45 months (range, 32-56 months) before imatinib interruption. Six patients displayed a molecular relapse with a detectable BCR-ABL transcript at 1, 1, 2, 3, 4, and 5 months. Imatinib was then reintroduced and led to a novel molecular response in most patients. Six other patients (50%) still have an undetectable level of BCR-ABL transcript after a median follow-up of 18 months (range, 9-24 months). We hypothesize that relapses observed within 6 months reflect the kinetics of undetectable dividing chronic myelogenous leukemia (CML) cells. Those cells may be eradicated or controlled in long-term nonrelapsing patients, as described in our study.
Extrait de http://bloodjournal.hematologylibrary.o ... g/109/1/58

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Voir The French trial called STIM (Stop Imatinib)
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