The critical issue is that he has had 10 years of imatinib. These are the patients who are most likely to benefit from a trial of cessation. The odd very low positive signal doesn’t seem to matter much according to the French A-STIM study. However you would like to see that the positive result is not the start of a trend. I would repeat and if the level is back to zero I would go ahead with a trial of cessation. If the next PCR result is positive I would probably continue imatinib and keep watching closely and stop once you get a zero reading again – unless the need to cease based on toxicity is compelling in which case I would give it a go anyway.

Cessation is a very reasonable option. Take a look at the Mahon presentation from the latest ASH on the EUROSKI study where 0.01 (MR4) was the target for stopping. Results look very good with a threshold for restarting being 0.1 or loss of MMR. If the results are valid by IS and you are able to do monthly monitoring at least for the first year and at least 2-3 monthly for the next couple, so that you can restart if necessary, go ahead. Of course, participation on a stopping study if possible is always preferred.

Trial of cessation is reasonable

78 yo male with chronic phase CML diagnosed in 2005. Treated with imatinib 400mg daily since then. Considering cessation because of some side-effects (diarrhoea, anaemia). His BCR-ABL levels are as below, basically 0 for the last 2 years apart from the 0.001 level at last assessment in October 2014. Is the small blip at 0.001 of concern or is a trial of cessation still reasonable?

22/OCT/14 0.001
01/MAY/14 0.000
17/OCT/13 0.000
11/APRIL/13 0.000
25/OCT/12 0.000