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This strategy that includes treatment change to a more powerful treatment before treatment discontinuation has not been evaluated in any of the clinical trials, and will be explored in the current study. One freee remained in MMR at the month follow-up.

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The potential medical benefits of successful cessation include minimization of drug-drug interactions, elimination of chronic side effects, and pregnancy without exposure to TKIs. In earlier studies, it was more stringent, and the trigger for reinitiating the treatment was the detection of the transcript.

The rationale for the Study De Ponatinib has shown to induce deeper molecular responses compared with imatinib. Since the seminal study of the French Group, led by Mahon and Reiffers, multiple trials have studied the potential role of discontinuation of imatinib to achieve a stable TFR.

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Hide detailed description Detailed Description: One decade ago, it was thought that cessation of Tyrosine Kinase Inhibitor TKI treatment in chronic myeloid leukemia in chronic phase CML-CP patients could be ineluctably followed by relapse, even in the setting of a complete molecular response. The experience is similar with patients treated with nilotinib upfront. Eligible patients have been ly treated with imatinib as unique tyrosine kinase inhibitor at least 4 years and have documented MR4 at least 12 months at the time of switch to ponatinib to study entry.

This provided the first evidence that achieving and maintaining deep molecular responses is a pre-requisite for successful therapy cessation.

Definition of relapse has also varied. Hence, physicians, as well as patients, have shown a strong interest to explore cessation strategies for BCR-ABL inhibitors. The showed that the probability of TFR by 48 weeks was In this framework, the purpose is to determine the rate of successful TFR within the first 48 weeks following cessation of treatment in patients who achieved MR4 on imatinib and maintained MR4 on ponatinib after a switch from imatinib.

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In the STIM study, in terms of regaining molecular response, 61 patients had a molecular recurrence, 56 regained undetectable BCR-ABL transcript level after a median of 4 months on imatinib range months. The rational of the ENESTop trial lies in this experience and explains its de: patients treated ly with imatinib, and having obtained a MR4.

This paradigm was mainly based on two facts: the absence of the known graft vs leukemia effect of bone marrow transplant, and the demonstration that quiescent stem cells were resistant to TKI. Response of Rescue Therapy after Relapse Patients after relapse were treated again, most vaalencia them with the TKI they received discontinuation.

However, cjat studies have set the definition of relapse as the loss of major molecular response MMR. Therefore, ponatinib treatment could increase the proportion of patients who could discontinue treatment successfully.

I offer online therapy via a secure platform Zoom - Issues related to low mood, worry, eating, relationships, or major life changes - I can offer therapy online or at two office locations in Valencia - Using evidence-based therapy methods tailored to you to instil self-understanding. A similar approach has been followed by the Japanese investigators, but with patients having treated with dasatinib in second line.

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Five patients did not return to undetectable transcript level: four remained treatment-free with detectable transcript range 0. After this phase, those patients with stable MR4.

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Other trials have explored valenica possibility of a consolidation therapy with second-generation TKIs 2GTKI in patients ly treated with imatinib. No loss of hematological response or progression to advanced phase was noted after stopping imatinib.

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