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Until recently, the main goal of chronic myeloid leukemia therapy was disease control with the best overall survival, which required lifelong treatment. However, currently, the treatment-free remission concept is becoming an important goal in clinical practice, and several tyrosine kinase inhibitors discontinuation studies have shown that round 50% of patients with a durable deep molecular response beyond major molecular response successfully interrupt tyrosine kinase inhibitors for at least three years without loss of molecular response. However, and regardless of the existing evidence, the exact conditions for attempting treatment-free remission remain poorly defined. Different authors tried to guide the clinical decision regarding this topic but there are some points that differ, namely with respect to the recommended duration of tyrosine kinase inhibitors therapy and the appropriate molecular response prior to treatment-free remission. The goal of this article is to propose an algorithm to guide clinical practice in Portugal concerning chronic phase-chronic myeloid leukemia patients who wish to attempt treatment-free remission, since there are no national guidelines.

the onset and progression of CLL. MYD88 mutations independently associate with shorter TTT in M-CLL subgroup, identifying cases with rapid progression. Introduction: Chronic lymphocytic leukemia (CLL) is a chronic lymphoproliferative disease characterized by highly biological heterogeneity and variable clinical course. Previous researches showed that 30%-40% of patients with CLL could survive for decades of years without initial need for treatment, while some patients rapidly succumb to the progression of disease. In recent years, data on prognostic value of molecular mutations and viral infections on CLL continue accumulating. Our study was determined to define variables correlated with time-to-treatment (TTT) in Chinese with chronic lymphocytic leukemia (CLL) and use these variables to develop a prognostic score. We determined correlation of the prognostic score with survival and compared this score with those developed for persons of predominately European descent with CLL in this study. Methods:We collected clinical, molecular, serologic and virological parameters of 334 newly diagnosed and untreated CLL patients. Utilizing Chi-square test, survival analysis, log-rank test and Cox hazard regression analysis, we checked the correlations between variables and prognosis of our patients.Results: By analyzing 334 newly diagnosed and untreated CLL patients without treatment indication, we demonstrated that Binet stage B/C, lymphocyte level, TP53 abnormality, IGHV non-mutation and evidence of HBV and EBV infection were independently associated with TTT in multivariate analyses. We used these data to construct a prognostic scoring system that divided subjects into three cohorts of low, intermediate and high risks with median TTTs of 102 months (95% confidence interval 50-154 months), 15 months (5-25 months) and 6 months (3-9 months; p-value for trend <0.001). Corresponding median OS from diagnosis were not reached, not reached and 73 months (55-91 months; p-value for trend <0.001).Conclusions: We improved current risk stratification for patients with untreated CLL using combined clinical, molecular and virological variables and defined three different risk groups with this novel stratifica- PORTUGUESE REAL-LIFE EXPERIENCE WITH IBRUTINIB OUTSIDE CLINICAL TRIALS -A MULTICENTER ANALYSIS

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