The iCMLf is delighted to launch its Regional Discussion Groups in Saudi Arabia. Supported by Novartis, this series of three online meetings on CML management began on the 3rd June and brings together global CML experts, alongside physicians and scientists from across the Kingdom to discuss the most important and evolving topics in the field.

The first discussion focused on the interconnected themes of TFR in Saudi Arabia: current practice, second and subsequent TFR attempts, and dose reduction as a pathway to TFR. The webinar featured international experts Professor Jorge Cortes (USA), Professor Dennis Kim (Canada), and Professor Giuseppe Saglio (Italy), alongside regional faculty Professor Naeem Chaudhri and Dr Ayel Yahya from Saudi Arabia.

Through a highly interactive, case-based format, 55 participants explored the complexities of patient selection, monitoring strategies, TKI sequencing, and practical approaches to maximising opportunities for successful TFR in routine clinical practice. The discussion highlighted both the growing confidence in TFR as a treatment goal and the need to individualise decisions based on patient characteristics, treatment history, and local healthcare realities.

The quality of discussion and the active engagement from participants demonstrated the value of creating a dedicated forum for Saudi Arabian clinicians to exchange experiences and discuss real-world challenges in CML management.

Key discussion themes

Expanding TFR beyond first-line therapy

A major focus of the discussion was the increasing acceptance of TFR as a treatment goal in selected patients receiving second- or later-line TKIs. While earlier guidelines were cautious about discontinuation beyond first-line therapy, the updated ELN recommendations now support TFR in carefully selected patients who switched treatment due to intolerance or who have achieved sustained deep molecular responses after subsequent lines of therapy.
Through a series of challenging real-world cases, experts agreed that treatment history should be interpreted carefully. Patients with slow responses or intolerance may still be excellent TFR candidates, particularly when they have achieved prolonged and stable deep molecular responses.

Duration of deep molecular response matters

Across multiple cases, the experts repeatedly highlighted the importance of the duration of deep molecular response (DMR) as one of the strongest predictors of successful TFR.
While current guidelines recommend a minimum of two years of sustained DMR, several experts noted that longer durations, often five to eight years, provide additional reassurance, particularly for patients attempting TFR after second- or third-line therapy or after a previous unsuccessful discontinuation attempt.
Participants agreed that prolonged DMR may be more important than the specific TKI used when assessing suitability for TFR.

Can patients try TFR more than once?

The possibility of second TFR attempts generated considerable discussion. Experts emphasised that failure of a first TFR attempt should not automatically exclude future discontinuation attempts.
Several experts shared their experience of successfully discontinuing therapy after re-establishing deep molecular responses and maintaining them for a longer period before reattempting TFR.
In most cases, the preferred strategy after relapse was to restart the same TKI that had previously been effective and well tolerated, rather than switching therapies solely to improve the likelihood of TFR success.

Dose reduction as a bridge to TFR

The second session explored whether TKI dose reduction can help prepare patients for successful treatment discontinuation.
Experts discussed growing experience with dose optimisation strategies, particularly for patients with stable deep molecular responses. Dose reduction was viewed not only as a means of reducing long-term toxicity but also as an opportunity to increase patient confidence before complete treatment cessation.
Several faculty members reported routinely reducing TKI doses once deep molecular responses have been achieved and maintained, while carefully monitoring molecular responses. This approach may help patients adapt psychologically to the concept of treatment discontinuation while preserving disease control.

Real-world monitoring challenges

Monitoring requirements remain one of the major practical barriers to TFR implementation in Saudi Arabia.
While guidelines recommend frequent molecular monitoring during the first six months after treatment discontinuation, participants acknowledged that access to testing and associated costs can pose challenges in some healthcare settings.
The panel agreed that close monitoring remains essential, particularly during the first six months when most relapses occur. However, there was broad support for adapting monitoring schedules pragmatically, when necessary, provided patients remain under careful supervision and have rapid access to treatment re-initiation if required.

TFR in special patient populations

The discussion also addressed TFR in more complex scenarios, including patients with kinase domain mutations, multiple prior TKIs, significant comorbidities, and pediatric patients transitioning to adult care.
Experts stressed that treatment decisions should remain individualised. Even patients with prior resistance, multiple treatment lines, or advanced age may be considered for TFR if they achieve prolonged deep molecular responses and can be monitored appropriately.
A pediatric case highlighted the potential additional benefits of TFR in younger patients, including reducing long-term treatment exposure during critical developmental years. This case was referred into the iCMLf pediatric advisors’ network for further consultation and support on follow up.'

Conclusion

The inaugural Saudi Arabian Regional Discussion Group demonstrated the growing interest and experience with treatment-free remission across the region.

The discussion reinforced that TFR is no longer limited to carefully selected first-line patients. With appropriate patient selection, prolonged deep molecular responses, and access to reliable molecular monitoring, successful TFR may also be achievable after second- and subsequent-line therapies, as well as following previous unsuccessful discontinuation attempts.

Participants also highlighted the emerging role of dose reduction strategies as a practical pathway toward TFR, helping to balance treatment efficacy, toxicity management, and patient confidence.

Upcoming CML Discussions in Saudi Arabia:

Meeting 2: July 1st, 2026

Topics:

Anticipating and managing acute TKI toxicity and adverse events
CML in pregnancy

Speakers:
a) International Faculty:
Professor Giuseppe Saglio (Turin), Professor Michael Mauro (New York)
b) Regional Faculty:
Dr Iman Alhamzi (Jeddah), Professor Binyam Usman (Jeddah)

Meeting 3: August 26th, 2026

Topics:

Management of young CML patients in Saudi Arabia
Quality of life for CML patients

Speakers: To be confirmed

Thanks to Novartis KSA for their support of these educational meetings.

Treatment-free remission in focus: inaugural Saudi Arabian Regional Discussion Group