Long-term outcome of chronic myeloid leukemia patients treated frontline with imatinib

• DOI: 10.1038/leu.2015.152
• Publication Date: 2015-06-19T07:15:11Z
• Authors: F Castagnetti; G Gugliotta; M Breccia; F Stagno; A Iurlo; F Albano; E Abruzzese; B Martino; L Levato; T Intermesoli; P Pregno; G Rossi; F Gherlinzoni; P Leoni; F Cavazzini; C Venturi; S Soverini; N Testoni; G Alimena; M Cavo; G Martinelli; F Pane; G Saglio; G Rosti; M Baccarani
• Keywords: DIAGNOSED CHRONIC-PHASE; Male; Cancer Research; Time Factors; bcr-abl; Fusion Proteins, bcr-abl; EARLY INTERVENTION; Antineoplastic Agent; 0302 clinical medicine; Hematology; Cancer Research; Anesthesiology and Pain Medicine; Antineoplastic Combined Chemotherapy Protocols; 80 and over; Chronic; Aged, 80 and over; Leukemia; PATIENTS RECEIVING IMATINIB; DIAGNOSED CHRONIC-PHASE; CHRONIC MYELOGENOUS LEUKEMIA; PATIENTS RECEIVING IMATINIB; TYROSINE KINASE INHIBITORS; BCR-ABL1 TRANSCRIPT LEVELS; EARLY MOLECULAR RESPONSE; CML WORKING PARTY; 3-YEAR FOLLOW-UP; EUROPEAN LEUKEMIANET; 400 MG; CHRONIC MYELOGENOUS LEUKEMIA; Hematology; Middle Aged; Prognosis; BCR-ABL1 TRANSCRIPT LEVELS; 3. Good health; Treatment Outcome; Retreatment; EARLY MOLECULAR RESPONSE; Imatinib Mesylate; Female; Human; Adult; 400 MG; Time Factor; Adolescent; Prognosi; Protein Kinase Inhibitor; Antineoplastic Agents; Follow-Up Studie; Young Adult; 03 medical and health sciences; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Humans; Protein Kinase Inhibitors; CYTOGENETIC RESPONSE; Aged; Antineoplastic Combined Chemotherapy Protocol; Fusion Proteins; Adolescent; Adult; Aged; Aged, 80 and over; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Female; Follow-Up Studies; Fusion Proteins, bcr-abl; Humans; Imatinib Mesylate; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Male; Middle Aged; Prognosis; Protein Kinase Inhibitors; Retreatment; Time Factors; Treatment Outcome; Young Adult; Hematology; Cancer Research; Anesthesiology and Pain Medicine; Adolescent; Adult; Aged; Aged, 80 and over; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Female; Follow-Up Studies; Fusion Proteins, bcr-abl; Humans; Imatinib Mesylate; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Male; Middle Aged; Prognosis; Protein Kinase Inhibitors; Retreatment; Time Factors; Treatment Outcome; Young Adult; Hematology; Cancer Research; Anesthesiology and Pain Medicine; Medicine (all); 1ST-LINE TREATMENT; Anesthesiology and Pain Medicine; BCR-ABL Positive; FOLLOW-UP; Myelogenous; Follow-Up Studies

For almost 10 years imatinib has been the therapeutic standard of chronic myeloid leukemia. The introduction of other tyrosine kinase inhibitors (TKIs) raised a debate on treatment optimization. The debate is still heated: some studies have protocol restrictions or limited follow-up; in other studies, some relevant data are missing. The aim of this report is to provide a comprehensive, long-term, intention-to-treat, analysis of 559 newly diagnosed, chronic-phase, patients treated frontline with imatinib. With a minimum follow-up of 66 months, 65% of patients were still on imatinib, 19% were on alternative treatment, 12% died and 4% were lost to follow-up. The prognostic value of BCR-ABL1 ratio at 3 months (⩽10% in 81% of patients) was confirmed. The prognostic value of complete cytogenetic response and major molecular response at 1 year was confirmed. The 6-year overall survival was 89%, but as 50% of deaths occurred in remission, the 6-year cumulative incidence of leukemia-related death was 5%. The long-term outcome of first-line imatinib was excellent, also because of second-line treatment with other TKIs, but all responses and outcomes were inferior in high-risk patients, suggesting that to optimize treatment results, a specific risk-adapted treatment is needed for such patients.