De-escalation Strategy of Tyrosine Kinase Inhibitors Before Treatment Discontinuation in Patients With Chronic Myeloid Leukemia: Dose Reduction Versus Discontinuation - a Multicenter, Prospective, Randomized Controlled Study
试验速览
- 阶段
- 4 期
- 状态
- 尚未招募
- 入组人数
- 280
- 试验地点
- 1
- 主要终点
- 2-year molecular relapse-free survival
研究概览
简要总结
The goal of this clinical trial is to learn if a 1-year dose-reduction strategy with tyrosine kinase inhibitors (TKIs) - before complete discontinuation - works to improve treatment-free remission in adults with chronic-phase chronic myeloid leukaemia (CML) who have already achieved stable deep molecular response and are eligible to stop therapy. It will also learn about the safety of this gradual reduction approach.
The main questions it aims to answer are:
Does the dose-reduction strategy lead to a higher 2-year molecular relapse-free survival rate (maintaining major molecular response, BCR-ABL1 ≤0.1%) compared with immediate TKI discontinuation? What medical problems (adverse events) do participants experience during and after dose reduction, and how do they differ from those in the direct-stop group? Researchers will compare the dose-reduction group (reduced daily TKI for 12 months, then 1-year follow-up) with the direct-discontinuation group (immediate stop, 2-year follow-up) to see whether gradual reduction is superior in preserving molecular remission. In addition, they will compare the changes in T-cell subsets between the two groups to explore immune mechanisms that may influence treatment-free remission.
Participants will:
Be randomly assigned to either dose reduction or immediate discontinuation; Take reduced TKI (or no drug) daily for 1 year, followed by 1-year observation (total 24 months); Visit the clinic every 2 months for the first 6 months, then every 3 months thereafter, for physical exams, blood tests, molecular monitoring (BCR-ABL1 PCR), and ECG; Have T-cell subsets measured by flow cytometry at months 3, 6, 12, and 24; Complete quality-of-life questionnaires (EORTC QLQ-CML24) at baseline and at months 3, 6, 12, and 24; Report all adverse events; if MMR is lost, they must restart full-dose TKI and be monitored monthly until remission is regained;
详细描述
Chronic myeloid leukemia (CML) patients treated with tyrosine kinase inhibitors (TKIs) have significantly prolonged survival, but long-term medication leads to adverse events, financial burden, and reduced quality of life, creating a strong desire for treatment discontinuation. Chinese CML patients are diagnosed at a younger median age (45-50 years) than Western populations, exposing them to TKIs earlier and making treatment-free remission (TFR) a particularly urgent goal. Current studies show that direct discontinuation after achieving deep molecular response yields a 2-year molecular relapse-free survival rate of approximately 50%, with some patients experiencing "withdrawal syndrome." Recent evidence suggests that TKI dose reduction may lower relapse risk and reduce adverse effects without compromising efficacy. Therefore, investigating whether a tapering strategy before discontinuation is superior to immediate cessation is of great significance for optimising CML management and improving patients' quality of life. This study aims to investigate the difference in 2-year molecular relapse-free survival between Chinese CML patients who undergo gradual TKI dose reduction and those who discontinue TKI immediately after meeting the criteria for treatment-free remission, and to evaluate whether the dose-reduction strategy is superior to immediate discontinuation in improving molecular relapse-free survival.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 80 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Age ≥ 18 years.
- •Patients in chronic phase, with no history of accelerated phase (AP-CML) or blast phase (BP-CML).
- •Treatment with a first-generation TKI for ≥5 years; treatment with a second-generation TKI for ≥3 years; for resistant patients, treatment with an effective TKI for ≥5 years.
- •Prior evidence of detectable BCR::ABL1 transcripts. Stable deep molecular response (DMR) for >2 years (MR⁴, BCR::ABL1¹⁵ ≤0.01%), with at least 4 test results meeting the criterion and each test at least 3 months apart.
- •Availability of reliable qPCR testing with a sensitivity of at least MR⁴·⁵ (BCR::ABL1¹⁵ ≤0.0032%), and test results available within 2 weeks.
排除标准
- •Received stem cell transplantation before study entry.
- •Presence of diseases associated with immunodeficiency, such as syphilis, hepatitis C, or HIV.
- •Concurrent participation in other clinical studies.
- •Having another malignant disease, unless the other primary malignancy is currently of no clinical significance or does not require active intervention.
- •Major surgery within 4 weeks, or not recovered from a previous surgery.
- •Pregnancy, lactation, or women planning to become pregnant.
- •Eastern Cooperative Oncology Group performance status (ECOG PS) ≥
- •Inability to comply with protocol procedures or to attend follow-up visits on time.
- •Known allergy or contraindication to the study drug (active pharmaceutical ingredient and/or excipients).
- •Any other condition that the investigator considers makes the patient unsuitable for enrolment.
研究组 & 干预措施
De-escalation group
12-month reduced-dose TKI (e.g., imatinib 200 mg, nilotinib 300 mg, dasatinib 50 mg, flumatinib 200/400 mg, or olverembatinib 20 mg daily) followed by 1-year observation
干预措施: Halve TKIs (Drug)
Discontinuation group
Participants discontinue all tyrosine kinase inhibitor (TKI) therapy immediately after enrollment. No study drug is administered during the 24-month follow-up period.
干预措施: Withdrawal TKIs (Drug)
结局指标
主要结局
2-year molecular relapse-free survival
时间窗: From enrollment until molecular relapse (loss of MMR) or death from any cause, whichever came first, assessed up to 2 years.
Molecular relapse is defined as loss of major molecular response (MMR; BCR-ABL1 \> 0.1%) at a single time point.
次要结局
- Event-Free Survival (EFS)(From date of enrollment until the date of first documented confirmed loss of MMR (BCR-ABL1 > 0.1%), progression to advanced phase, or death from any cause, whichever came first, assessed up to 24 months.)
- Changes in T cell subsets(Changes in T cell subsets at 3 months, 6 months, 12 months and 24 months after enrollment.)