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Br J Haematol. 2019 May;185(4):718-724. doi: 10.1111/bjh.15826. Epub 2019 Mar 6.

Discontinuation of imatinib in children with chronic myeloid leukaemia in sustained deep molecular remission: results of the STOP IMAPED study.

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Departments of Paediatric Oncology/Haematology, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
Departments of Paediatric Oncology/Haematology, Poitiers University Hospital, Poitiers, France.
Paediatric Haemato-Oncology, Medical Faculty, Technical University, Dresden, Germany.
Belarusian Research Centre for Paediatric Oncology, Haematology and Immunology, Minsk, Belarus.
Departments of Paediatric Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.


This international study aimed to assess the effect of imatinib discontinuation in paediatric patients with chronic myeloid leukaemia (CML) after deep molecular remission (DMR) had been achieved and maintained for at least 2 years. The primary endpoint of this analysis was the molecular relapse-free survival, estimated by the non-parametric Kaplan-Meier method. Major endpoint was the estimated rate of patients without molecular relapse at 6 months. Fourteen patients were enrolled; 4 patients maintained DMR with a follow-up of 24 (two patients), 34 and 66 months, respectively, whereas 10 patients relapsed. All molecular relapses occurred within 6 months (median 3 months, range 1-6) after imatinib discontinuation. The overall probability of maintaining DMR at 6 months was 28·6%. No parameters associated with molecular relapse could be identified. Keeping in mind the rarity of paediatric CML, which contributed to the small size of the cohort, our findings illustrate that imatinib cessation after sustained DMR is successful in only limited numbers of patients, whereas much higher rates are reported in adult patients. Further research is needed to extend the cohort of paediatric CML patients who might achieve treatment-free remission with an ideal prerequisite of predicting the occurrence of molecular relapse l after imatinib cessation.


chronic myeloid leukaemia; deep molecular remission; discontinuation of imatinib; paediatric CML; treatment-free remission


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