背景:无治疗缓解(TFR)已成为慢性粒细胞白血病(CML)的主要目标。酪氨酸激酶抑制剂(TKI)剂量优化对于管理不良事件至关重要。提高临床实践的依从性。在实现深层分子反应(DMR)的人中,一些数据表明,停药前TKI剂量减少不会改变实现TFR的成功率,但这是有争议的。然而,全剂量TKI的CML患者的生活质量(QoL)和心理健康数据,低剂量TKI,和TKI停药是有限的。此外,最近的证据表明TKI剂量减少和剂量减少后停药的可行性,这可能会改变CML患者对TKI停药的看法。
方法:我们使用在线问卷进行了一项横断面研究,以探索QoL,不同剂量TKI患者的心理健康,以及将减少TKI剂量作为停药前奏的观点。
结果:分析中包括1450个响应。44.3%的受访者表示TKI治疗对其QoL有中度至重度影响。17%的受访者有中度至重度焦虑。24.4%的受访者患有中度至重度抑郁症。在1326名没有停药的患者中,1055(79.6%)患者报告说,由于担心长期用药的副作用,他们会尝试停用TKI(67.9%),财政负担(68.7%),QoL差(77.9%),怀孕需求(11.6%),服用TKI时的焦虑和抑郁(20.8%),TKI治疗不便(22.2%)。接受全剂量TKI治疗的817名患者中有613名(75.0%)表示,他们更喜欢在剂量减少后停止TKI治疗之前尝试减少剂量,而31名(3.8%)则更喜欢在停止前不减少剂量。
结论:TKI剂量减少显示患者QoL和心理健康有显著改善,与TKI停药的效果相当。大多数患者表示,他们倾向于在停止TKI治疗前减少剂量。在临床实践中,TKI剂量减少可以被认为是从全剂量治疗到停药的桥梁。我们的结果表明,酪氨酸激酶抑制剂(TKI)剂量减少显示患者的生活质量和心理健康的显著改善,与TKI停药的效果相当。大多数患者希望将来停止TKI。与直接停药相比,减少剂量后停用TKI更容易接受。在临床实践中,TKI剂量减少可以被认为是从全剂量治疗到停药的桥梁。请不要犹豫与我联系,如果进一步澄清是需要与此提交。
Treatment-free remission (TFR) has become the main target for chronic myeloid leukemia (CML). Tyrosine kinase inhibitors (TKI) dose optimization is crucial in managing adverse events, and improving adherence in clinical practice. In persons achieving a deep molecular response (DMR), some data suggest TKI dose reduction before discontinuation does not change success rate of achieving TFR, but this is controversial. However, data on quality-of-life (QoL) and mental health in CML patients with full-dose TKI, low-dose TKI, and TKI discontinuation are limited. Moreover, recent evidence indicating the feasibility of TKI dose reduction and discontinuation after dose reduction, which may change CML patients\' perspectives on TKI discontinuation.
We conducted a cross-sectional study using online questionnaires to explore the QoL, mental health in patients with diverse TKI dose, and perspective on TKI dose reduction as a prelude to discontinuation.
1450 responses were included in the analysis. 44.3% of respondents reported a moderate-to-severe impact of TKI treatment on their QoL. 17% of respondents had moderate-to-severe anxiety. 24.4% of respondents had moderate-to-severe depression. In 1326 patients who had not discontinued their medication, 1055 (79.6%) patients reported they would try TKI discontinuation because of concerns over side effects of long-term medication (67.9%), financial burden (68.7%), poor QoL (77.9%), pregnancy needs (11.6%), anxiety and depression while taking TKI (20.8%), inconvenience of TKI treatment (22.2%). 613 of 817 (75.0%) patients on full-dose TKI therapy indicated they preferred trying a dose reduction before discontinuing TKI therapy after dose reduction compared with 31 (3.8%) preferring no dose reduction before stopping.
TKI dose reduction showed a significant improvement of patients\' QoL and mental health, comparable to the effect of TKI discontinuation. Most patients indicated they preferred dose reduction before stopping TKI therapy. In clinical practice, TKI dose reduction can be considered as a bridge from full-dose treatment to discontinuation. Our results showed that tyrosine kinase inhibitors (TKI) dose reduction showed a significant improvement of patients\' quality-of-life and mental health, comparable to the effect of TKI discontinuation. Most patients desire to discontinue TKI in the future. TKI discontinuation after dose reduction is more acceptable compared to discontinuing it directly. In clinical practice, TKI dose reduction can be considered as a bridge from full-dose treatment to discontinuation. Please do not hesitate to contact me in case further clarification is needed with this submission.