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Leukemia. 2015 Sep;29(9):1823-31. doi: 10.1038/leu.2015.152. Epub 2015 Jun 19.

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

Author information

1
Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L and A Seràgnoli', University of Bologna, 'S Orsola-Malpighi' University Hospital, Bologna, Italy.
2
Chair of Hematology, 'La Sapienza' University, Roma, Italy.
3
Chair of Hematology, University of Catania, Catania, Italy.
4
Oncohematology of the Elderly Unit, Oncohematology Division, IRCCS Ca' Granda - Maggiore University Hospital, Milano, Italy.
5
Chair of Hematology, University of Bari, Bari, Italy.
6
Hematology Unit, 'S Eugenio' Hospital, Roma, Italy.
7
Hematology Unit, Azienda Ospedaliera 'Bianchi-Melacrino-Morelli', Reggio Calabria, Italy.
8
Hematology Unit, 'Pugliese-Ciaccio' Hospital, Catanzaro, Italy.
9
Hematology Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
10
Hematology Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino, Italy.
11
Hematology Unit, Azienda Ospedaliera 'Spedali Civili', Brescia, Italy.
12
Hematology Unit, 'Ca' Foncello' Hospital, Treviso, Italy.
13
Chair of Hematology, Torrette University Hospital, Ancona, Italy.
14
Chair of Hematology, Azienda Ospedaliero Universitaria Arcispedale S Anna, University of Ferrara, Ferrara, Italy.
15
Department of Biochemistry and Medical Biotechnologies, 'Federico II' University, Napoli, Italy.
16
Chair of Hematology, Department of Clinical and Biological Sciences, 'S Luigi Gonzaga' University Hospital, University of Torino, Orbassano (TO), Italy.
17
Department of Hematology and Oncology 'L and A Seràgnoli', University of Bologna, Bologna, Italy.

Abstract

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.

PMID:
26088952
DOI:
10.1038/leu.2015.152
[Indexed for MEDLINE]

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