Alliance 2: The iCMLf TFR Alliance

Maximising achievement of TFR while minimising failed TFR attempts and other negative outcomes

The iCMLf also formed a second Alliance under the banner of CURE - the iCMLf Treatment-Free-Remission (TFR) Alliance. The mission of the iCMLf TFR Alliance is to maximise achievement of TFR while minimising failed TFR attempts and other negative outcomes.

Background

The dramatic success of tyrosine kinase inhibitors (TKIs) has led to the widespread perception that chronic myeloid leukemia (CML) has become another chronic disease, where lifelong commitment to pharmacological control is the paradigm. Recent clinical trials demonstrate that some CML patients who have achieved stable deep molecular response can safely stop their therapy without relapsing. Furthermore, those who are unsuccessful in their cessation attempt can safely re-establish remission after restarting their TKI therapy. Hence, the concept of treatment-free remission (TFR) is currently being discussed intensively in the CML community. This is changing our approach for the many CML patients who have achieved a stable deep molecular response on long-term TKI therapy as well as the many CML patients who have not achieved a stable deep molecular response. A greater understanding regarding the key determinants of TFR is needed to enable us to make TFR an achievable goal for the majority of our CML patients.

Planned priorities of the TFR Alliance

• Develop and assess clinical predictors of TFR
• Develop and assess biomarkers of TFR
• Clinical registries and trials of TFR
• Virtual tissue bank of TFR samples
• Disseminate a correlative study collection and storage protocol for TFR studies
• Assess safety of current TFR practice
• Frequency, management and mechanisms of withdrawal syndrome
• Assess long-term outcomes - is TFR safer than long-term TKI therapy for patients in deep molecular response (DMR)?

iCMLf Global TFR Registry

The iCMLf is calling for applications to build and maintain a global registry of TFR cases, for the predominant purpose of improving our understanding regarding the determinants of TFR.
The call for expressions of interest is now closed.

Expressions of interest should be no more than a total of 2 pages outlining briefly:

• Project proposal including specific aims
• What makes their proposed registry unique
• Methodology and statistical analysis plan
• Relevant experience and achievements including any existing data from retrospective or existing patients
• Potential sources of additional funding
• Sustainability of the registry and broad budget outline

Selected applicants will be invited to submit detailed proposals for the registry in early March 2021 and would have 8 weeks to prepare a final application. These will be peer reviewed by a panel of CML experts.

More information on the call for proposals can be found here

It is envisaged that the establishment phase of the registry will take place from June 2021 to June 2022, but a timeline and a detailed budget will be required for full applications.

Aim of the iCMLf Global TFR Registry

The aim of the iCMLf Global TFR Registry is to build an International registry of patients who have (1) attempted to achieve TFR and/or (2) will attempt to achieve TFR, by integrating clinical data from the collaborating members of the TFR alliance who have established local or regional TFR registries. The purpose of the global registry is to develop and validate predictors of TFR success, look at other aspects of TFR outcomes (late relapse, etc.), and (critically) facilitate exchange of clinically annotated samples from registry patients to further our understanding about the biological and molecular features of TFR.

Current iCMLf TFR Alliance members

• Timothy Hughes (SAHMRI / University of Adelaide) (Chair)
• Jane F Apperley (Imperial College, London)
• Charles Chuah (Duke-NUS Medical School, Singapore and Department of Haematology, Singapore General Hospital)
• Richard Clark (University of Liverpool)
• Simone Claudiani (Imperial College Healthcare NHS Trust, London)
• Jorge Cortes (Georgia Cancer Center, Augusta)
• Michael Deininger (Huntsman Cancer Institute, University of Utah, Salt Lake City)
• Brian J Druker (Oregon Health & Science University Knight Cancer Institute, Portland and Howard Hughes Medical Institute, Portland)
• J. Valentin Garcia Gutierrez (Hospital Universitario Ramón Y Cajal)
• Jan Geissler (CML Advocates Network)
• Nobuko Hijiya (Columbia University, New York)
• Carlo Gambacorti-Passerini (University of Milano Bicocca, San Gerardo Hospital, Monza)
• Andreas Hochhaus (Universitätsklinikum Jena)
• Dennis Kim (Princess Margaret Cancer Centre, Toronto)
• Dong-Wook Kim (Seoul St. Mary's Hospital Seoul)
• Francois-Xavier Mahon (University of Bordeaux)
• Michael J Mauro (Memorial Sloan Kettering Cancer Center, New York)
• Dragana Milojkovic (Imperial College Healthcare NHS Trust, London)
• Satu Mustjoki (University of Helsinki)
• Tiong Ong (Duke NUS Medical School)
• Carolina Pavlovsky (Fundaleu, Buenos Aires)
• Jerry P Radich (Fred Hutchinson Cancer Center, Seattle)
• Delphine Réa (Hospital Saint-Louis, Paris)
• Susanne Saußele (University of Mannheim)
• Giora Sharf (CML Advocates Network)
• Naoto Takahashi (Akita University, Akita)
• Ravi Bhatia (University of Alabama at Birmingham)