I don't think anybody knows the answer to this question in children. As far as I know there are several trials ongoing in adult Ph+ CML regarding the safety of stopping TKI treatment. I would imagine that future pediatric practice will follow the results of these studies. Although most children present in chronic phase many would advocate that at least all presenting with acceleretad phase or blast crisis should receive a stem cell transplant.

However, this does not answer your question. A good article from 2012 (How I treat childhood CML Jeffrey R. Andolina, Steven M. Neudorf, and Seth J. Corey, Blood 2012 enclosed as attachment) advocates continuing TKI indefinetely but as mentioned above this recommendation may change pending results from adult studies. At present I think adult hematologists in Sweden still recommend lifelong treatment

No time limit.It depends on TC.if < 20,000/cu.mm, stop drug and follow up.

the Philadelphia chromosome is the result of moving the abl proto - oncogene to the point of bcr with the formation of a new product

- Abl (oncogene of Abelson - tyrosinekinase)

Appears enabled tyrosinekinase without the possibility

normal suppression - BCR-ABL kinase.

Imatinib is a reversible inhibitor of tumor .Сells try with him

"to cope" . You can increase the dose of imatinib, but then there

most toxicity.

I think that when reached (stand) remission to stop the use of imatinib in the treatment of:

In case of relapse to search for other substances, communicating

with bcr-abl receptor (modifications of molecules of imatinib -

nilotinib, dasatinib,bosutinib, bafetinib - a lot. In cduce negative dynamics to inhibit cell path: v-Abl / PDGFR / C-Kit

I don't think anybody knows the answer to this question in children. As far as I know there are several trials ongoing in adult Ph+ CML regarding the safety of stopping TKI treatment. I would imagine that future pediatric practice will follow the results of these studies. Although most children present in chronic phase many would advocate that at least all presenting with acceleretad phase or blast crisis should receive a stem cell transplant.

However, this does not answer your question. A good article from 2012 (How I treat childhood CML Jeffrey R. Andolina, Steven M. Neudorf, and Seth J. Corey, Blood 2012 enclosed as attachment) advocates continuing TKI indefinetely but as mentioned above this recommendation may change pending results from adult studies. At present I think adult hematologists in Sweden still recommend lifelong treatment

Hi

1.Your  patient is treated by ALLOGENIC HSCT ?

2.Negative test are after conventional chemotherapy or  after HSCT ?

3.JAK2 mutation is removed by IMATINIB?

If negative BCR-ABL gene by peripheral RQ-PCR < 10-5 (International Scale) has continued for more than 2 years, stop therapy may be available like the adult patient. However. the careful monitoring for MRD by RQ-PCR is required after the stop therapy. We have to comfirm that TKI woudl be useful again after re-start the therapy in children as seen in the adults from publications.   

 imatinib is the best initial treatment for patients newly diagnosed with chronic myeloid leukemia (CML) in chronic phase, a number of questions remain unanswered. For example, (1) Is imatinib the best initial treatment for every chronic-phase patient? (2) For how long should the drug be continued in patients who have achieved and maintain a complete molecular response? 

I think the trail studies with nilotinib for specific time will explain the time limite in treatment of chronic myeloid leukemia

As long as it is effective. Lifelong for now. It is not known whether you can stop.

In adults there are now several stopping studies for which results have been reported in abstract form or full publication.  In each case, the molecular relapse rate has ranged from 30-60% in the first 6-12 months even for patients with undetectable quantitative RT-PCR for BCR-ABL for at least  2 years.  Almost all patients however have responded to retreatment.  While data are not specifically available in children, the biology of the disease is such that it should behave similarly.

thanks for your response

my patient is continuing Imatinib since 15 months ago

his JAK chromosome became negative after 6 months of treatment, and Ph+, after 12 months.

Now his spleen is normal, CBC in normal ranges, and patient is stable and grows normally.

please refer to this article:

Ghon M.Goldman.How I treat chronic myeloid leukemia in the Imatinib era.blood J;2007