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CML Treatment-Free Remission — RACP Adult Medicine MCQ

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HardHaematologyCML Treatment-Free RemissionRACP Adult Medicine

A 68-year-old woman with chronic myeloid leukaemia in sustained deep molecular response (BCR-ABL1 undetectable for >2 years) on imatinib asks about treatment-free remission (TFR). What criteria must be met to attempt TFR?

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Correct answer: C — Duration of TKI therapy ≥3 years with DMR ≥2 years

TKI discontinuation (treatment-free remission) can be attempted in chronic-phase CML patients who have been on TKI therapy for ≥3 years (some guidelines say ≥5 years) and have sustained deep molecular response (MR4.0 or better – BCR-ABL1 ≤0.01%) for ≥2 years. Molecular monitoring must be available monthly for the first 6 months, then every 6 weeks for 6 months, then 3-monthly indefinitely. Approximately 50% of patients maintain TFR; those who lose molecular response should promptly restart TKI (response is regained in >95%).

Reference: eTG – 2025 – Haematology; ELN – 2020 – CML Guidelines; EURO-SKI Trial