Potential Tyrosine Kinase Inhibitor Therapy Discontinuation for Patients With Chronic Myeloid Leukemia in a VA...

Some patients with chronic myeloid leukemia (CML) are eligible for tyrosine kinase inhibitor (TKI) discontinuation, which can reduce health system costs and may result in fewer adverse effects (AEs). This project sought to evaluate the potential cost avoidance and health outcomes associated with TKI discontinuation, including CML relapse, changes in reported AEs, long-term remission, and TKI withdrawal syndrome.

Patients with chronic phase CML who had an active order for a TKI were eligible for discontinuation. Patients needed to be on TKI therapy for ≥ 3 years and have a stable molecular response. Patients were excluded if they had a history of advanced accelerated phase CML, a previous TKI discontinuation trial, nonadherence, or if they did not want to discontinue TKI. Oncology clinical pharmacy practitioners at each Veterans Integrated Services Network (VISN) 21 facility were notified of eligible patients. Fifteen VISN 21 patients were eligible for discontinuation as of October 2024, with a potential annual cost avoidance of $1.2 million if discontinued. A dashboard was developed to allow for ongoing TKI discontinuation in eligible patients.

Discussions of TKI discontinuation with patients with CML led to collaboration with the patient care team and potential for significant cost avoidance without negatively impacting patient outcomes. Barriers to therapy discontinuation included patient concern for relapse, risk of discontinuation syndrome, the need for close monitoring, and required clinician buy-in.