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CML — SCE Medical Oncology MCQ

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HardImmunotherapy & Targeted TherapyCMLSCE Medical Oncology

A 60-year-old woman with CML on imatinib 400 mg achieves a major molecular response (BCR::ABL1 ≤0.1% IS) sustained for 2 years. She asks about stopping therapy. What criterion must be met for treatment-free remission (TFR) to be attempted?

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Correct answer: C — Sustained deep molecular response (MR4.0 or MR4.5) for ≥2 years with ≥3 years total TKI therapy

TKI cessation (treatment-free remission, TFR) can be attempted in CML patients who have achieved and maintained a sustained deep molecular response (MR4.0 = BCR::ABL1 ≤0.01% or MR4.5 = ≤0.0032%) for at least 2 years, with a minimum of 3 years total TKI therapy. Approximately 40-60% of patients maintain remission off therapy. Monthly molecular monitoring for the first year is mandatory. Rapid molecular relapse (loss of MMR) requires immediate TKI restart, with virtually all patients regaining response.

Reference: ESMO 2024 CML Guidelines; STIM/EURO-SKI trials; NICE TA251 CML pathway