《肿瘤瞭望》：经过TKI治疗后患者持续处于MR4.5状态，如果该患者考虑停药，您还会参考哪些指标?

　　Baccarani教授：我建议已达到MR4.5的患者停止TKI治疗，当然我不会特别强调什么，只是建议患者存在停止治疗的可能，因为即便出现复发，再次治疗也是安全的。而且不需要达到MR4.5，只要是MR4就足以停药，但TKI总的治疗持续时间应当至少4年。

　I would advise this patient in MR4.5 to discontinue the treatment. I would not make this recommendation specifically but would advise the patient that it is possible to discontinue the treatment because if there were a relapse， it would be safe to go back on treatment. It is not necessary at MR4.5. At MR4， it would be sufficient， but the total duration of TKI treatment should be at least four years.

　　《肿瘤瞭望》：您在临床实践中，对选择停药的患者您会怎样进行监控?譬如多久检查一次比较合适?

　　Baccarani教授：我们需要对每位停药的患者进行监控，可以采用RT-PCR，每个月一次，共一年，然后每二个月一次检测一年，然后再每三个月一次。我们所能做到的仅此而已。

　Any patient who discontinues treatment must be monitored with RT (real time) quantitative PCR every month (every 4-6 weeks) for a year， then every two months for the second year then every three months. Beyond that， nobody knows.

　　《肿瘤瞭望》：当停用TKI疾病复发后，重新启动TKI治疗时，药物选择需要注意什么？治疗反应同初始治疗有差别吗？

　　Baccarani教授：这个问题很难回答，因为相关的经验非常有限。已被证实的是，如果重新开始已停止的治疗，同样的药物，同样的剂量， 99%~100%的患者可以再次达到深度反应。是否更换TKI药物，需要考虑药物的不良反应来决定。对于那些由于药物的不良反应而终止治疗的患者，选用其它的TKI是明智的。我们目前还没有足够的临床证据表明在上述情况下二代TKI是否会更好，但有可能会更好。

　It is very difficult to answer those questions because experience is limited. What is true and confirmed is that if you return to the treatment that was discontinued (same drug， same dose)， 99%-100% of patients experience the same deep response. Whether it is advisable to change the TKI depends on the side effects of the TKI. For these patients， if one of the reasons for discontinuation of treatment was the side effects then it would be wise to move to another TKI. We do not know if the second-generation TKIs are better in this scenario， but that may be the case.

　　《肿瘤瞭望》：CML急变移植后TKI治疗选择以及TKI可能带来的益处。

　　Baccarani教授：这同样是一个非常棘手的问题，因为接受造血干细胞移植的患者数目很小，大部分患者选择再次进行TKI治疗。在这种情况下，二代TKI可能效果更佳，这种治疗策略可以积极预防复发，要好于不做任何措施等待复发。

　Again this is a difficult question because the number of patients that have undergone hematopoietic stem cell transplantation is small. For the great majority of patients it is advisable to repeat a TKI， and in this case a second-generation TKI which will be more potent. This approach is probably better than waiting for a relapse.