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CML Hepatosplenomegaly — RACP Adult Medicine MCQ

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HardHaematologyCML HepatosplenomegalyRACP Adult Medicine

A 46-year-old with chronic-phase CML has taken a TKI for six years and maintained MR4.5 for three years with reliable high-quality PCR monitoring. She asks to stop therapy because of chronic adverse effects. What is the best response?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Attempt supervised TKI cessation with frequent PCR and a prespecified restart threshold

Explanation lettering: B = shown as A · E = shown as B · A = shown as D · D = shown as E

A is correct because prolonged TKI exposure, sustained deep molecular response, informed adherence to frequent PCR and rapid restart after loss of major molecular response make a structured treatment-free-remission attempt reasonable. B monitors too infrequently and restarts too late. C imposes unsupported requirements that deny an established option for selected patients. D is too insensitive and infrequent for early relapse. E uses an unvalidated taper and insensitive surveillance. Most relapses occur early and usually regain response after therapy resumes.

Reference: eviQ, Chronic myeloid leukaemia imatinib: https://www.eviq.org.au/haematology/leukaemias/chronic-myeloid-leukaemia/362-chronic-myeloid-leukaemia-imatinib; Leukaemia Foundation Australia, CML treatment-free remission: https://www.leukaemia.org.au/news/expert-interview-series-dr-david-yeung-discusses-cml/