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Predicting complete cytogenetic response and subsequent progression-free survival in 2060 patients with CML on imatinib treatment: the EUTOS score. Blood 2011; 118:686-92. [PMID: 21536864 DOI: 10.1182/blood-2010-12-319038] [Citation(s) in RCA: 301] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The outcome of chronic myeloid leukemia (CML) has been profoundly changed by the introduction of tyrosine kinase inhibitors into therapy, but the prognosis of patients with CML is still evaluated using prognostic scores developed in the chemotherapy and interferon era. The present work describes a new prognostic score that is superior to the Sokal and Euro scores both in its prognostic ability and in its simplicity. The predictive power of the score was developed and tested on a group of patients selected from a registry of 2060 patients enrolled in studies of first-line treatment with imatinib-based regimes. The EUTOS score using the percentage of basophils and spleen size best discriminated between high-risk and low-risk groups of patients, with a positive predictive value of not reaching a CCgR of 34%. Five-year progression-free survival was significantly better in the low- than in the high-risk group (90% vs 82%, P = .006). These results were confirmed in the validation sample. The score can be used to identify CML patients with significantly lower probabilities of responding to therapy and survival, thus alerting physicians to those patients who require closer observation and early intervention.
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Morra E, Lazzarino M, Alimena G, Liberati AM, Grignani F, Mandelli F, Bernasconi C. The Role of Interferon in the Treatment of Chronic Myelogenous Leukemia: Results and Prospects. Leuk Lymphoma 2009. [DOI: 10.3109/10428199209053562] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Enrica Morra
- Chair Of Hematology, University of Pavia, and Division of Hematology, Istituto Scientifico Policlinico S. Matteo, Pavia, Italy
- Institute of Hematology, University ‘La Sapienza’, Rome; Institute of Internal Medicine. University of Perugia, Italy
| | - Mario Lazzarino
- Chair Of Hematology, University of Pavia, and Division of Hematology, Istituto Scientifico Policlinico S. Matteo, Pavia, Italy
- Institute of Hematology, University ‘La Sapienza’, Rome; Institute of Internal Medicine. University of Perugia, Italy
| | - Giuliana Alimena
- Chair Of Hematology, University of Pavia, and Division of Hematology, Istituto Scientifico Policlinico S. Matteo, Pavia, Italy
- Institute of Hematology, University ‘La Sapienza’, Rome; Institute of Internal Medicine. University of Perugia, Italy
| | - Anna M. Liberati
- Chair Of Hematology, University of Pavia, and Division of Hematology, Istituto Scientifico Policlinico S. Matteo, Pavia, Italy
- Institute of Hematology, University ‘La Sapienza’, Rome; Institute of Internal Medicine. University of Perugia, Italy
| | - Fausto Grignani
- Chair Of Hematology, University of Pavia, and Division of Hematology, Istituto Scientifico Policlinico S. Matteo, Pavia, Italy
- Institute of Hematology, University ‘La Sapienza’, Rome; Institute of Internal Medicine. University of Perugia, Italy
| | - Franco Mandelli
- Chair Of Hematology, University of Pavia, and Division of Hematology, Istituto Scientifico Policlinico S. Matteo, Pavia, Italy
- Institute of Hematology, University ‘La Sapienza’, Rome; Institute of Internal Medicine. University of Perugia, Italy
| | - Carlo Bernasconi
- Chair Of Hematology, University of Pavia, and Division of Hematology, Istituto Scientifico Policlinico S. Matteo, Pavia, Italy
- Institute of Hematology, University ‘La Sapienza’, Rome; Institute of Internal Medicine. University of Perugia, Italy
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Wedelin C, Björkholm M, Mellstedt H, Gahrton G, Holm G. Clinical findings and prognostic factors in chronic myeloid leukemias. ACTA MEDICA SCANDINAVICA 2009; 220:255-60. [PMID: 3465200 DOI: 10.1111/j.0954-6820.1986.tb02760.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Ninety-one previously untreated patients with chronic myeloid leukemia admitted to three Stockholm hospitals 1973-1978 were studied. There were 49 men and 42 women with a mean age of 56 years (range 15-93). Sixty-five patients were Philadelphia chromosome (Ph1) positive and 17 were Ph1 negative (mean age 51 and 70 years, respectively). After a mean observation time of 5.2 years, 64 patients had deceased, 45 of them in blast transformation. A low hemoglobin value and a high total blast cell count at diagnosis were associated with a poor prognosis in the Ph1 positive group. Other routine clinical and laboratory variables were of subordinate prognostic importance. Early splenectomy in 15 Ph1 positive patients did not improve survival. Median survival from diagnosis was 38 months for Ph1 positive patients as compared to 12 months for the Ph1 negative group.
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Druker BJ, Sawyers CL, Capdeville R, Ford JM, Baccarani M, Goldman JM. Chronic myelogenous leukemia. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2002:87-112. [PMID: 11722980 DOI: 10.1182/asheducation-2001.1.87] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The treatment recommendations for chronic myelogenous leukemia (CML) are evolving rapidly. In the past year, pegylated interferon and STI571 (Gleevec, imatinib mesylate), a Bcr-Abl tyrosine kinase inhibitor, have become commercially available and non-myeloablative stem cell transplants continue to be refined. Clinicians and patients face a bewildering array of treatment options for CML. In this article Dr. Sawyer reviews the clinical results with STI571 and ongoing investigations into mechanisms of resistance to STI571. Given the newness of STI571, a practical overview on the administration of STI571 is presented by Drs. Druker and Ford, focusing on aspects such as optimal dose, management of common side effects, and potential drug interactions. The most recent data on interferon-based regimens are reviewed by Dr. Baccarani in the third section. In the last section Dr. Goldman presents recent results of allogeneic stem cell transplants, including the reduced intensity conditioning regimens. Lastly, the proposed place of each of these treatments in the management of CML patients is addressed to assist in deciding amongst treatment options for CML patients.
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Affiliation(s)
- B J Druker
- Oregon Health and Science University, Portland, OR 97201-3098, USA
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Surgery in Hematologic Malignancies. Surg Oncol 1989. [DOI: 10.1007/978-3-642-72646-0_74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Results of a prospective randomized trial of early splenectomy in chronic myeloid leukemia. The Italian Cooperative Study Group on Chronic Myeloid Leukemia. Cancer 1984; 54:333-8. [PMID: 6372988 DOI: 10.1002/1097-0142(19840715)54:2<333::aid-cncr2820540226>3.0.co;2-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The role of early splenectomy in the management of chronic myeloid leukemia (CML) was investigated in a multicentric study with 21 contributing Hospitals. One hundred eighty-nine patients younger than 66 years of age and previously untreated, were first seen between November 1974 and May 1977, were randomized to splenectomy or to nonsplenectomy , were given the same chemotherapy (busulfan, and courses of arabinosyl cytosine, 6-thioguanine, and daunomycin), and were followed up for more than 5 years. Median survival was 45 months. No relationship of splenectomy to survival length could be shown either in the whole series, or in several subgroups that were selected according to presentation features and stage classification. Thromboembolic and vascular accidents were more frequent in the splenectomy group, and this was associated with more difficult control of platelet count. Early splenectomy is not recommended for treatment of CML.
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