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Klil-Drori AJ, Yin H, Azoulay L, Del Corpo A, Harnois M, Gratton MO, Olney HJ, Delage R, Laneuville P, Mollica L, Busque L, Assouline SE. Molecular monitoring of therapeutic milestones and clinical outcomes in patients with chronic myeloid leukemia. Cancer 2019; 125:618-625. [PMID: 30423211 DOI: 10.1002/cncr.31835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 09/11/2018] [Accepted: 10/01/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND In the current study, the authors determined whether adhering to molecular monitoring guidelines in patients with chronic myeloid leukemia (CML) is associated with major molecular response (MMR) and assessed barriers to adherent monitoring. METHODS Newly treated patients with CML from the Quebec province-wide CML registry from 2005 to 2016 were included. Timely polymerase chain reaction (tPCR) was defined as the molecular assessment of BCR-ABL1 at the 3-month, 12-month, and 18-month time points from the initiation of tyrosine kinase inhibitor (TKI) therapy. The cohort was analyzed as a nested case-control study. Cases with a first-ever MMR (BCR-ABL1 ≤0.1%, assessed at any time during follow-up) were matched to up to 5 controls by duration of TKI therapy, volume of patients with CML at the treatment center, year of cohort entry, and age. Odds ratios (ORs) for the performance of tPCR and MMR were adjusted for sex, comorbidities, type of TKI, and other important covariates. RESULTS The cohort included 496 patients. Of 392 MMR events, 67.9% occurred before 18 months. The performance of tPCR was associated with a doubling of the MMR rate (OR, 2.23; 95% confidence interval [95% CI], 1.56-3.21) and was similar with 1 to 3 tPCRs performed (P = .67). Furthermore, tPCRs at 3 months (OR, 2.77; 95% CI, 1.81-4.23) and 12 months (OR, 3.00; 95% CI, 1.64-5.49) were associated with achieving early MMR, whereas tPCRs at 18 months were not (OR, 1.23; 95% CI, 0.80-1.89). Low-volume centers were found to have lower adherence to tPCR (OR, 0.60; 95% CI, 0.40-0.89). CONCLUSIONS Timely molecular assessment at 3 months and 12 months appears to benefit patients with CML. Adherence to timely monitoring should be encouraged, especially in low-volume treatment centers.
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Affiliation(s)
- Adi J Klil-Drori
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Hui Yin
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
| | - Laurent Azoulay
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Epidemiology, McGill University, Montreal, Quebec, Canada.,Department of Oncology, McGill University, Montreal, Quebec, Canada
| | - Alexa Del Corpo
- Segal Cancer Center, Jewish General Hospital, Montreal, Quebec, Canada
| | - Michaël Harnois
- Department of Hematology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | | | - Harold J Olney
- Department of Hematology and Transfusion Medicine, University of Montreal Health Centre, Montreal, Quebec, Canada.,University of Montreal, Montreal, Quebec, Canada
| | - Robert Delage
- University of Quebec Center of Hematology and Oncology, University of Quebec Health Centre, Quebec City, Quebec, Canada
| | - Pierre Laneuville
- Department of Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Luigina Mollica
- Department of Hematology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada.,University of Montreal, Montreal, Quebec, Canada
| | - Lambert Busque
- Department of Hematology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada.,University of Montreal, Montreal, Quebec, Canada
| | - Sarit E Assouline
- Department of Oncology, McGill University, Montreal, Quebec, Canada.,Segal Cancer Center, Jewish General Hospital, Montreal, Quebec, Canada
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Eskazan AE, Tiribelli M. Does switching to a second-generation tyrosine kinase inhibitor or increasing imatinib dose have long-term benefits in chronic myeloid leukemia patients with suboptimal responses under upfront standard-dose of imatinib? Leuk Res 2018; 74:55-56. [PMID: 30296661 DOI: 10.1016/j.leukres.2018.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/19/2018] [Accepted: 09/23/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Ahmet Emre Eskazan
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey.
| | - Mario Tiribelli
- Division of Hematology and BMT, Department of Medical Area, University of Udine, Udine, Italy
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Song HY, Noh H, Choi SY, Lee SE, Kim SH, Kee KM, Yoo HL, Lee MY, Kang KH, Suh JH, Yang SY, Jang EJ, Lee JI, Kim DW. BCR-ABL1 transcript levels at 4 weeks have prognostic significance for time-specific responses and for predicting survival in chronic-phase chronic myeloid leukemia patients treated with various tyrosine kinase inhibitors. Cancer Med 2018; 7:5107-5117. [PMID: 30171671 PMCID: PMC6198233 DOI: 10.1002/cam4.1753] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 08/03/2018] [Accepted: 08/07/2018] [Indexed: 01/28/2023] Open
Abstract
The present study aimed to assess the clinical impact of BCR‐ABL1 transcript levels determined at an earlier time point than the 3‐month early molecular response (EMR) in chronic‐phase chronic myeloid leukemia (CML‐CP) patients. BCR‐ABL1 transcript levels of CML‐CP patients (n = 258; median age, 43 [range, 18‐81] years) treated with various tyrosine kinase inhibitors (TKIs) were determined at 4 weeks (28 ± 3 days) and at every 3 months of treatment initiation. At 4 weeks, receiver operating characteristic curves revealed that cutoff values of BCR‐ABL1 transcripts for achieving major molecular responses (MMRs) by 12 and 60 months were 40.89% and 39.16%, respectively (95% CI, 0.658‐0.772 and 95% CI, 0.643‐0.758; P < 0.0001). With 40% of BCR‐ABL1 transcripts at 4 weeks (very early MR; VEMR), patients with VEMR achieved higher 3‐month EMR and 4‐week VEMR significantly associated with higher cumulative incidences of 5‐year MMR (89.1% vs 72.3%; P < 0.001) and 5‐year deep molecular response (DMR) (56.5% vs 29.4%; P = 0.001). Furthermore, event‐free survival (EFS)‐a (93.0% vs 84.8%; P = 0.068) and EFS‐b (71.1% vs 57.9%; P = 0.061) by 5 years were also marginally significant. VEMR and 3‐month EMR were achieved in 89 patients, with significantly superior outcomes. In multivariate analyses, lower leukocyte count (P = 0.008) and frontline second‐generation TKI therapy size (P < 0.001) were significantly associated with VEMR achievement, but not baseline BCR‐ABL1 level and CML duration. In conclusion, the 4‐week BCR‐ABL1 transcript levels including VEMR could be important to predict long‐term outcomes and may provide additional information about innate intrinsic sensitivity to CML among individuals.
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Affiliation(s)
- Hye-Young Song
- Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Hayeon Noh
- Department of Pharmacy, College of Pharmacy, Yonsei University, Incheon, Korea
| | - Soo Young Choi
- Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Sung-Eun Lee
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Soo-Hyun Kim
- Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Kyung-Mi Kee
- Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Hea-Lyun Yoo
- Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Mi-Young Lee
- Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Ki-Hoon Kang
- Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Ji-Hyung Suh
- Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Seon-Young Yang
- Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Eun-Jung Jang
- Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Jangik I Lee
- Department of Pharmacy, Seoul National University Hospital, Seoul, Korea
| | - Dong-Wook Kim
- Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea.,Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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