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Yin X, Li X, Jiang H, Lin X, Ma Z, Chen X, Teng Q, Zhang J, Jin J. CFL1 is Implicated in Chronic Myeloid Leukemia Response during Imatinib Therapy. J Cancer 2024; 15:2424-2430. [PMID: 38495482 PMCID: PMC10937266 DOI: 10.7150/jca.92202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/22/2024] [Indexed: 03/19/2024] Open
Abstract
Cofilin (CFL1) is one critical member of the actin deploy family (ADF). Overexpression of CFL1 is associated with aggressive features and poor prognosis in malignancies. We evaluated the expression of CFL1 in patients with chronic myeloid leukemia in the chronic phase (CML-CP), acute myelocytic leukemia (AML) and healthy controls. The role of CFL1 in imatinib therapy was also investigated using cell line. We found that the expression of CFL1 was lower in CML patients than that in healthy controls, and was significantly upregulated after imatinib therapy (p<0.05). CML patients with lower CFL1 achieved higher Major molecular response (MMR) rate after 6 months of imatinib therapy (p<0.05). Cofilin, P-cofilin and F-actin, especially branched F-actin were all upregulated after imatinib therapy. The lower CFL1 expression before treatment may predicts a better response to imatinib. Imatinib affects F-actin remodeling in CML patients by regulating CFL1 expression and activity.
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Affiliation(s)
- Xiufeng Yin
- Department of Hematology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, P R China
| | - Xia Li
- Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, P R China
| | - Hao Jiang
- Department of Hematology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, P R China
| | - Xiangjie Lin
- Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, P R China
| | - Zhixin Ma
- Department of Laboratorial Medicine, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, P R China
- Clinical Prenatal Diagnosis Center, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, P R China
| | - Xiaochang Chen
- Department of Hematology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, P R China
| | - Qibei Teng
- Department of Hematology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, P R China
| | - Jin Zhang
- Department of Hematology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, P R China
| | - Jie Jin
- Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, P R China
- Zhejiang Provincial Key Lab of Hematopoietic Malignancy, Zhejiang University, Hangzhou, P R China
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Singh AK, Vidyadhari A, Bhurani D, Agrawal N, Ahmed R, Sharma M. Effect of Imatinib treatment on renal anaemia in chronic myeloid leukemia patients. J Oncol Pharm Pract 2023; 29:1928-1934. [PMID: 36862651 DOI: 10.1177/10781552231160113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
PURPOSE In this study, we investigate renal function and anaemia during imatinib treatment in patients with chronic myeloid leukaemia. METHODS The patients with chronic myeloid leukaemia with chronic phase who had been treated with only imatinib for 12 months at Rajiv Gandhi Cancer Institute and Research Centre (New Delhi, India) were enrolled and prospectively analysed. The chronic renal impairment parameters, including estimated glomerular filtration rate and haemoglobin levels for anaemia from June 2020 to June 2022, were monitored in newly diagnosed in patients with chronic myeloid leukaemia-chronic phase. The data were analysed by SPSS software version 22. RESULTS In total 55 patients with chronic myeloid leukaemia chronic phase who had been on imatinib for 12 months were monitored. The mean estimated glomerular filtration rate was significantly decreased (74 ± 14 to 59 ± 12 mL/min/1.73m2, p < 0.001) with a decrease in mean haemoglobin levels after 12 months (10.9 ± 2.01 to 9.0 ± 1.02, p < 0.004). The decreased estimated glomerular filtration rate was negatively correlated with haemoglobin levels after 1 year of imatinib administration (correlation coefficient = 0.892, R2 = 0.7976, p < 0.05). CONCLUSION We recommended close monitoring of renal function and haemoglobin levels in patients with chronic myeloid leukaemia patients.
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Affiliation(s)
- Avinash Kumar Singh
- Department of Pharmaceutical Medicine (Division of Pharmacology), School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
- Department of Hematology & Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - Arya Vidyadhari
- Department of Pharmaceutics, School of Pharmaceutical Education & Research, Jamia Hamdard, New Delhi, India
| | - Dinesh Bhurani
- Department of Hematology & Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - Narendra Agrawal
- Department of Hematology & Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - Rayaz Ahmed
- Department of Hematology & Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - Manju Sharma
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
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Kronick O, Chen X, Mehra N, Varmeziar A, Fisher R, Kartchner D, Kota V, Mitchell CS. Hematological Adverse Events with Tyrosine Kinase Inhibitors for Chronic Myeloid Leukemia: A Systematic Review with Meta-Analysis. Cancers (Basel) 2023; 15:4354. [PMID: 37686630 PMCID: PMC10486908 DOI: 10.3390/cancers15174354] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/24/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
Chronic myeloid leukemia (CML) is treated with tyrosine kinase inhibitors (TKI) that target the pathological BCR-ABL1 fusion oncogene. The objective of this statistical meta-analysis was to assess the prevalence of other hematological adverse events (AEs) that occur during or after predominantly first-line treatment with TKIs. Data from seventy peer-reviewed, published studies were included in the analysis. Hematological AEs were assessed as a function of TKI drug type (dasatinib, imatinib, bosutinib, nilotinib) and CML phase (chronic, accelerated, blast). AE prevalence aggregated across all severities and phases was significantly different between each TKI (p < 0.05) for anemia-dasatinib (54.5%), bosutinib (44.0%), imatinib (32.8%), nilotinib (11.2%); neutropenia-dasatinib (51.2%), imatinib (29.8%), bosutinib (14.1%), nilotinib (14.1%); thrombocytopenia-dasatinib (62.2%), imatinib (30.4%), bosutinib (35.3%), nilotinib (22.3%). AE prevalence aggregated across all severities and TKIs was significantly (p < 0.05) different between CML phases for anemia-chronic (28.4%), accelerated (66.9%), blast (55.8%); neutropenia-chronic (26.7%), accelerated (63.8%), blast (36.4%); thrombocytopenia-chronic (33.3%), accelerated (65.6%), blast (37.9%). An odds ratio (OR) with 95% confidence interval was used to compare hematological AE prevalence of each TKI compared to the most common first-line TKI therapy, imatinib. For anemia, dasatinib OR = 1.65, [1.51, 1.83]; bosutinib OR = 1.34, [1.16, 1.54]; nilotinib OR = 0.34, [0.30, 0.39]. For neutropenia, dasatinib OR = 1.72, [1.53, 1.92]; bosutinib OR = 0.47, [0.38, 0.58]; nilotinib OR = 0.47, [0.42, 0.54]. For thrombocytopenia, dasatinib OR = 2.04, [1.82, 2.30]; bosutinib OR = 1.16, [0.97, 1.39]; nilotinib OR = 0.73, [0.65, 0.82]. Nilotinib had the greatest fraction of severe (grade 3/4) hematological AEs (30%). In conclusion, the overall prevalence of hematological AEs by TKI type was: dasatinib > bosutinib > imatinib > nilotinib. Study limitations include inability to normalize for dosage and treatment duration.
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Affiliation(s)
- Olivia Kronick
- Laboratory for Pathology Dynamics, Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, GA 30332, USA
| | - Xinyu Chen
- Laboratory for Pathology Dynamics, Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, GA 30332, USA
| | - Nidhi Mehra
- Laboratory for Pathology Dynamics, Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, GA 30332, USA
| | - Armon Varmeziar
- Laboratory for Pathology Dynamics, Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, GA 30332, USA
| | - Rachel Fisher
- Laboratory for Pathology Dynamics, Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, GA 30332, USA
| | - David Kartchner
- Laboratory for Pathology Dynamics, Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, GA 30332, USA
| | - Vamsi Kota
- Department of Medicine, Hematology and Oncology, Georgia Cancer Center at Augusta University, Augusta, GA 30912, USA;
| | - Cassie S. Mitchell
- Laboratory for Pathology Dynamics, Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, GA 30332, USA
- The Machine Learning Center at Georgia Tech, Georgia Institute of Technology, Atlanta, GA 30332, USA
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Narlı Özdemir Z, Kılıçaslan NA, Yılmaz M, Eşkazan AE. Guidelines for the treatment of chronic myeloid leukemia from the NCCN and ELN: differences and similarities. Int J Hematol 2023; 117:3-15. [PMID: 36064839 DOI: 10.1007/s12185-022-03446-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 08/25/2022] [Accepted: 08/25/2022] [Indexed: 01/07/2023]
Abstract
Patients diagnosed with chronic myeloid leukemia (CML) in chronic phase can now have a life expectancy comparable to that of the general population thanks to the use of tyrosine kinase inhibitor (TKI) therapies. Although most patients with CML require lifelong TKI therapy, it is possible for some patients to achieve treatment-free remission. These spectacular results have been made possible by the development of superior treatment modalities as well as clinicians' efforts in strictly adhering to clinical guidelines such as the National Comprehensive Cancer Network (NCCN) and European Leukemia Network (ELN). CML treatment recommendations reported in these guidelines are the result of years of selecting and incorporating the most reliable evidence. In this review, we provide a synopsis of the differences and similarities that exist between the NCCN and ELN guidelines.
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Affiliation(s)
- Zehra Narlı Özdemir
- Department of Hematology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | | | - Musa Yılmaz
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ahmet Emre Eşkazan
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Fatih, Istanbul, Turkey.
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Szczepanek E, Chukwu O, Kamińska M, Wysogląd H, Cenda A, Zawada M, Jakóbczyk M, Wącław J, Sacha T. Long-term outcomes of patients with Chronic Myeloid Leukemia who commenced treatment with imatinib: a 20-year single-centre experience. Leuk Lymphoma 2022; 63:2213-2223. [DOI: 10.1080/10428194.2022.2068000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Elżbieta Szczepanek
- Department of Hematology, Jagiellonian University Medical College, Cracow, Poland
- Doctoral School in Medical Sciences and Health Sciences, Jagiellonian University Medical College, Cracow, Poland
| | - Ositadima Chukwu
- Department of Hematology, Jagiellonian University Medical College, Cracow, Poland
| | - Magdalena Kamińska
- Department of Hematology, Jagiellonian University Medical College, Cracow, Poland
| | - Hubert Wysogląd
- Department of Hematology, Jagiellonian University Medical College, Cracow, Poland
- Department of Hematology, Oncology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Agnieszka Cenda
- Department of Hematology, Jagiellonian University Medical College, Cracow, Poland
| | - Magdalena Zawada
- Department of Hematology Diagnostics, The University Hospital, Cracow, Poland
| | | | - Joanna Wącław
- Department of Hematology, Jagiellonian University Medical College, Cracow, Poland
| | - Tomasz Sacha
- Department of Hematology, Jagiellonian University Medical College, Cracow, Poland
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Frikha R, Kassar O, Elloumi M, Kamoun H. Assessment of molecular response to tyrosine kinase inhibitors in Tunisian Patients with Chronic Myeloid Leukemia. J Oncol Pharm Pract 2021; 28:1826-1831. [PMID: 34846219 DOI: 10.1177/10781552211048232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM This study was carried out to assess the minimal residual disease in Tunisian patients with chronic myeloid leukemia (CML) treated with tyrosine kinase inhibitors in routine clinical practice, to recognize potentially eligible carrier for treatment discontinuation, based on a molecular response (MR). PATIENTS AND METHODS A retrospective study was carried out in the Hospital University of Sfax, south of Tunisia from January 2016 to October 2020, including all CML patients in the chronic phase at diagnosis, treated with TKI (tyrosine kinase inhibitors) for a minimum duration of 6 months. Quantitative assessment of the BCR-ABL transcript was performed using the Cepheid Xpert BCR-ABL ultra-assay. Molecular response and outcome were evaluated, according to the European Leukemia Net guidelines. RESULTS A total of 162 CML patients were carried out. The median age was 50 years, the sex ratio M/F was 1.62. The rate of cumulative EMR; MMR and DMR was 80.8%; 73.8% and 55.9% respectively. According to the ELN criteria, 141 CML patients were evaluable. Optimal, suboptimal response and failure were noted in 81 (57.4%), 33(23.4%), and 27(19.1%) patients, respectively. Overall survival (OS) and progression-free survival (PFS) were 96.3% and 85%. Risk factors for an event (death/progression) were lack of EMR, MMR, and DMR (P < 0.05). Among 149 patients with sustained DMR; 14 (8.6%) CML patients have discontinued TKI therapy. CONCLUSION Despite the limit of our study (duration and size), the available real-life molecular responses with TKI therapy should be considered to identify potentially CML patients eligible for discontinuation of TKI therapy.
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Affiliation(s)
- Rim Frikha
- Department of Medical Genetics, Hospital Hédi Chaker of Sfax, Tunisia
| | - Olfa Kassar
- Department of Haematology, Hospital Hédi Chaker of Sfax, Tunisia
| | - Moez Elloumi
- Department of Haematology, Hospital Hédi Chaker of Sfax, Tunisia
| | - Hassen Kamoun
- Department of Medical Genetics, Hospital Hédi Chaker of Sfax, Tunisia
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Integrated Genomic Analysis Identifies ANKRD36 Gene as a Novel and Common Biomarker of Disease Progression in Chronic Myeloid Leukemia. BIOLOGY 2021; 10:biology10111182. [PMID: 34827175 PMCID: PMC8615070 DOI: 10.3390/biology10111182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 02/05/2023]
Abstract
Simple Summary Chronic myeloid leukemia is a type of blood cancer that is regarded as a success story in determining the exact biological origin, pathogenesis and development of a molecularly targeted (mutation-specific) therapy that has led to successful treatment of this fatal cancer. It is caused by the BCR-ABL fusion gene, which is formed from the translocation between chromosomes 9 and 22. Anti-BCR-ABL drugs, known as tyrosine kinase inhibitors (TKIs), have led to long-term remissions in more than 80% of CML patients and even cure in about one-third of patients. Nevertheless, many patients face drug resistance, and disease progression occurs in about 30% of CML patients, leading to morbidities and mortality. Unfortunately, no biomarkers of CML progression are available due to a poor understanding of the mechanism of progression. Therefore, finding reliable molecular biomarkers of CML progression is one of the most attractive research areas in 21st-century cancer research. In this study, we report novel genomic variants exclusively found in all our advanced-phase CML patients. This study will help in identifying CML patients at risk of disease progression and timely therapeutic interventions to avoid or at least delay fatal disease progression in this cancer. Abstract Background: Chronic myeloid leukemia (CML) is initiated in bone marrow due to chromosomal translocation t(9;22) leading to fusion oncogene BCR-ABL. Targeting BCR-ABL by tyrosine kinase inhibitors (TKIs) has changed fatal CML into an almost curable disease. Despite that, TKIs lose their effectiveness due to disease progression. Unfortunately, the mechanism of CML progression is poorly understood and common biomarkers for CML progression are unavailable. This study was conducted to find novel biomarkers of CML progression by employing whole-exome sequencing (WES). Materials and Methods: WES of accelerated phase (AP) and blast crisis (BC) CML patients was carried out, with chronic-phase CML (CP-CML) patients as control. After DNA library preparation and exome enrichment, clustering and sequencing were carried out using Illumina platforms. Statistical analysis was carried out using SAS/STAT software version 9.4, and R package was employed to find mutations shared exclusively by all AP-/BC-CML patients. Confirmation of mutations was carried out using Sanger sequencing and protein structure modeling using I-TASSER followed by mutant generation and visualization using PyMOL. Results: Three novel genes (ANKRD36, ANKRD36B and PRSS3) were mutated exclusively in all AP-/BC-CML patients. Only ANKRD36 gene mutations (c.1183_1184 delGC and c.1187_1185 dupTT) were confirmed by Sanger sequencing. Protein modeling studies showed that mutations induce structural changes in ANKRD36 protein. Conclusions: Our studies show that ANKRD36 is a potential common biomarker and drug target of early CML progression. ANKRD36 is yet uncharacterized in humans. It has the highest expression in bone marrow, specifically myeloid cells. We recommend carrying out further studies to explore the role of ANKRD36 in the biology and progression of CML.
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Deininger MW, Shah NP, Altman JK, Berman E, Bhatia R, Bhatnagar B, DeAngelo DJ, Gotlib J, Hobbs G, Maness L, Mead M, Metheny L, Mohan S, Moore JO, Naqvi K, Oehler V, Pallera AM, Patnaik M, Pratz K, Pusic I, Rose MG, Smith BD, Snyder DS, Sweet KL, Talpaz M, Thompson J, Yang DT, Gregory KM, Sundar H. Chronic Myeloid Leukemia, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 18:1385-1415. [PMID: 33022644 DOI: 10.6004/jnccn.2020.0047] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chronic myeloid leukemia (CML) is defined by the presence of Philadelphia chromosome (Ph) which results from a reciprocal translocation between chromosomes 9 and 22 [t(9;22] that gives rise to a BCR-ABL1 fusion gene. CML occurs in 3 different phases (chronic, accelerated, and blast phase) and is usually diagnosed in the chronic phase. Tyrosine kinase inhibitor therapy is a highly effective first-line treatment option for all patients with newly diagnosed chronic phase CML. This manuscript discusses the recommendations outlined in the NCCN Guidelines for the diagnosis and management of patients with chronic phase CML.
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Affiliation(s)
| | - Neil P Shah
- UCSF Helen Diller Family Comprehensive Cancer Center
| | - Jessica K Altman
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | - Bhavana Bhatnagar
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | | | | | - Leland Metheny
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | - Kiran Naqvi
- The University of Texas MD Anderson Cancer Center
| | - Vivian Oehler
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | - Arnel M Pallera
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | - Keith Pratz
- Abramson Cancer Center at the University of Pennsylvania
| | - Iskra Pusic
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | - B Douglas Smith
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | - David T Yang
- University of Wisconsin Carbone Cancer Center; and
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Dakkoune M, Qachouh M, Zoukal S, Hassoune S, Khoubila N, Cherkaoui S, Lamchahab M, Rachid M, Madani A, Quessar A. Imatinib dans le traitement de la leucémie myéloide chronique au Maroc. Bull Cancer 2020; 107:861-866. [DOI: 10.1016/j.bulcan.2020.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 10/23/2022]
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Deng M, Guan X, Wen X, Xiao J, An X, Yu J. Clinical efficacy and safety of imatinib treatment in children and adolescents with chronic myeloid leukemia: A single-center experience in China. Medicine (Baltimore) 2020; 99:e19150. [PMID: 32049841 PMCID: PMC7035079 DOI: 10.1097/md.0000000000019150] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Chronic myeloid leukemia (CML) is relatively rare in childhood and few studies have reported the clinical use of imatinib (IM) in pediatric CML. In this study, we evaluated the efficacy and tolerability of IM in children and adolescents with CML.We investigated 21 patients under 18 years of age with newly diagnosed CML and treated with IM in Children's Hospital of Chongqing Medical University between May 2014 and February 2018. The disease was staged according to the European LeukemiaNet criteria and the IM dose was determined based on the disease stage. Cumulative responses and survival probabilities were estimated according to the Kaplan-Meier method.The estimated complete hematologic response rate of chronic phase-chronic myeloid leukemia (CML-CP) was 89.5% at 3 months. The complete cytogenetic response rates increased with time, reaching 47.4%, 73.7%, and 80.3% at 6, 12, and 24 months, respectively. The cumulative major molecular response rates were 42.1% and 76.3% at 12 and 24 months, respectively. With a median follow-up time of 33.8 months (range, 3.2-61.7 months), the estimated 2-year overall survival (OS) rate for CML was 95.2% (95% confidence interval [CI], 70.7%-99.3%). None of the CML-CP patients progressed to the accelerated phase or had a blast crisis. The 2-year OS and progression-free survival rates for the CML-CP cohort were both 100%, while the estimated 2-year event-free survival rate was 68% (95% CI, 42.1%-84.2%). None of the patients in this group had treatment-related deaths or IM discontinuation due to drug toxicities, and only 1 patient had a grade III-IV nonhematologic adverse event. Overall, anemia was the most common adverse effect and 42.9% of patients had a decrease in bone mineral density.IM was effective and the adverse effects were well-tolerated throughout the follow-up period in Chinese CML patients under 18 years of age.
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Affiliation(s)
- Mengyue Deng
- Department of Hematology and Oncology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation Base of Child Development and Critical Disorders; Children's Hospital of Chongqing Medical University
- Chongqing Key Laboratory of Pediatrics, Chongqing, P.R China
| | - Xianmin Guan
- Department of Hematology and Oncology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation Base of Child Development and Critical Disorders; Children's Hospital of Chongqing Medical University
- Chongqing Key Laboratory of Pediatrics, Chongqing, P.R China
| | - Xianhao Wen
- Department of Hematology and Oncology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation Base of Child Development and Critical Disorders; Children's Hospital of Chongqing Medical University
- Chongqing Key Laboratory of Pediatrics, Chongqing, P.R China
| | - Jianwen Xiao
- Department of Hematology and Oncology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation Base of Child Development and Critical Disorders; Children's Hospital of Chongqing Medical University
- Chongqing Key Laboratory of Pediatrics, Chongqing, P.R China
| | - Xizhou An
- Department of Hematology and Oncology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation Base of Child Development and Critical Disorders; Children's Hospital of Chongqing Medical University
- Chongqing Key Laboratory of Pediatrics, Chongqing, P.R China
| | - Jie Yu
- Department of Hematology and Oncology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation Base of Child Development and Critical Disorders; Children's Hospital of Chongqing Medical University
- Chongqing Key Laboratory of Pediatrics, Chongqing, P.R China
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The proportion of different BCR-ABL1 transcript types in chronic myeloid leukemia. An international overview. Leukemia 2019; 33:1173-1183. [PMID: 30675008 DOI: 10.1038/s41375-018-0341-4] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 11/28/2018] [Indexed: 01/31/2023]
Abstract
There are different BCR-ABL1 fusion genes that are translated into proteins that are different from each other, yet all leukemogenic, causing chronic myeloid leukemia (CML) or acute lymphoblastic leukemia. Their frequency has never been systematically investigated. In a series of 45503 newly diagnosed CML patients reported from 45 countries, it was found that the proportion of e13a2 (also known as b2a2) and of e14a2 (also known as b3a2), including the cases co-expressing e14a2 and e13a2, was 37.9% and 62.1%, respectively. The proportion of these two transcripts was correlated with gender, e13a2 being more frequent in males (39.2%) than in females (36.2%), was correlated with age, decreasing from 39.6% in children and adolescents down to 31.6% in patients ≥ 80 years old, and was not constant worldwide. Other, rare transcripts were reported in 666/34561 patients (1.93%). The proportion of rare transcripts was associated with gender (2.27% in females and 1.69% in males) and with age (from 1.79% in children and adolescents up to 3.84% in patients ≥ 80 years old). These data show that the differences in proportion are not by chance. This is important, as the transcript type is a variable that is suspected to be of prognostic importance for response to treatment, outcome of treatment, and rate of treatment-free remission.
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Khoury HJ, Williams LA, Atallah E, Hehlmann R. Chronic Myeloid Leukemia: What Every Practitioner Needs to Know in 2017. Am Soc Clin Oncol Educ Book 2017; 37:468-479. [PMID: 28561719 DOI: 10.1200/edbk_175712] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The prognosis of chronic phase chronic myeloid leukemia (CML) has improved so that life expectancy for patients responding to tyrosine kinase inhibitors (TKIs) is now equivalent to age-matched controls. Attention should be paid to comorbidities that impact survival. The success of TKI therapy can be easily and reliably assessed at well-accepted time points using quantitative polymerase chain reaction (PCR) standardized to the international scale. Patient-reported outcome (PRO) tools are readily available for use in the clinic and provide complementary information on the tolerance of TKIs. Effectively managing adverse events of TKIs can improve compliance and quality of life. Discontinuation of TKIs is the next frontier in CML. In select patients with sustained deep molecular remission, a discontinuation of TKI is associated with a durable treatment-free remission in approximately 50%. Patient engagement in their discontinuation can be achieved through a provider multi-team coaching, is complementary to the available guidelines, and may provide an additional safety net so that these discontinuations remain safe when applied in general practices.
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Affiliation(s)
- Hanna Jean Khoury
- From the Winship Cancer Institute, Emory University, Atlanta, GA; The University of Texas MD Anderson Cancer Center, Houston, TX; Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Loretta A Williams
- From the Winship Cancer Institute, Emory University, Atlanta, GA; The University of Texas MD Anderson Cancer Center, Houston, TX; Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Ehab Atallah
- From the Winship Cancer Institute, Emory University, Atlanta, GA; The University of Texas MD Anderson Cancer Center, Houston, TX; Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Rüdiger Hehlmann
- From the Winship Cancer Institute, Emory University, Atlanta, GA; The University of Texas MD Anderson Cancer Center, Houston, TX; Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
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13
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Castagnetti F, Di Raimondo F, De Vivo A, Spitaleri A, Gugliotta G, Fabbiano F, Capodanno I, Mannina D, Salvucci M, Antolino A, Marasca R, Musso M, Crugnola M, Impera S, Trabacchi E, Musolino C, Cavazzini F, Mineo G, Tosi P, Tomaselli C, Rizzo M, Siragusa S, Fogli M, Ragionieri R, Zironi A, Soverini S, Martinelli G, Cavo M, Vigneri P, Stagno F, Rosti G, Baccarani M. A population-based study of chronic myeloid leukemia patients treated with imatinib in first line. Am J Hematol 2017; 92:82-87. [PMID: 27770583 DOI: 10.1002/ajh.24591] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/10/2016] [Accepted: 10/17/2016] [Indexed: 01/14/2023]
Abstract
Chronic myeloid leukemia (CML) treatment is based on company-sponsored and academic trials testing different tyrosine kinase inhibitors (TKIs) as first-line therapy. These studies included patients selected according to many inclusion-exclusion criteria, particularly age and comorbidities, with specific treatment obligations. In daily clinical practice (real-life), inclusion-exclusion criteria do not exist, and the treatment outcome does not only depend on the choice of first-line TKI but also on second- and third-line TKIs. To investigate in a real-life setting the response and the outcome on first-line imatinib, with switch to second generation TKIs in case of unsatisfying response or intolerance, we analyzed all newly diagnosed patients (N = 236), living in two Italian regions, registered in a prospective study according to population-based criteria and treated front-line with imatinib. A switch from imatinib to second-generation TKIs was reported in 14% of patients for side effects and in 24% for failure or suboptimal response, with an improvement of molecular response in 57% of them. The 5-year overall survival (OS) and leukemia-related survival (LRS) were 85% and 93%, respectively; the 4-year rates of MR3.0 and MR4.0 were 75% and 48%, respectively. Cardiovascular complications were reported in 4% of patients treated with imatinib alone and in 6% of patients receiving nilotinib as second-line. Older age (≥70 years) affected OS, but not LRS. These data provide an unbiased reference on the CML management and on the results of TKI treatment in real-life, according to ELN recommendations, using imatinib as first-line treatment and second-generation TKIs as second-line therapy. Am. J. Hematol. 92:82-87, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Fausto Castagnetti
- Department of Oncology and Hematology; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
- Department of Experimental, Diagnostic and Specialty Medicine; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
| | - Francesco Di Raimondo
- Division of Hematology, A.O.U. Policlinico “Vittorio Emanuele,”; University of Catania; Catania Italy
| | - Antonio De Vivo
- Department of Oncology and Hematology; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
- Department of Experimental, Diagnostic and Specialty Medicine; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
| | - Antonio Spitaleri
- Division of Hematology, A.O.U. Policlinico “Vittorio Emanuele,”; University of Catania; Catania Italy
| | - Gabriele Gugliotta
- Department of Oncology and Hematology; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
- Department of Experimental, Diagnostic and Specialty Medicine; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
| | - Francesco Fabbiano
- Division of Hematology and Bone Marrow Transplantation; Ospedali Riuniti Villa Sofia - Cervello; Palermo Italy
| | - Isabella Capodanno
- Division of Hematology; Arcispedale Santa Maria Nuova, IRCCS; Reggio Emilia Italy
| | | | - Marzia Salvucci
- Division of Hematology; “Santa Maria delle Croci” Hospital; Ravenna Italy
| | - Agostino Antolino
- Service of Immunohematology and Transfusion Medicine; Azienda Ospedaliera Provinciale; Ragusa Italy
| | - Roberto Marasca
- Division of Hematology; Modena University Hospital, University of Modena and Reggio Emilia; Modena Italy
| | - Maurizio Musso
- Division of Hematology; Clinica La Maddalena; Palermo Italy
| | - Monica Crugnola
- Division of Hematology and Bone Marrow Transplantation; University Hospital; Parma Italy
| | | | - Elena Trabacchi
- Division of Hematology and Bone Marrow Transplantation; “Guglielmo da Saliceto” Hospital; Piacenza Italy
| | - Caterina Musolino
- Division of Hematology; “G. Martino” University Hospital, University of Messina; Italy
| | - Francesco Cavazzini
- Division of Hematology; “Sant'Anna” University Hospital, University of Ferrara; Ferrara Italy
| | - Giuseppe Mineo
- Division of Hematology; “S.Vincenzo” Hospital; Taormina ME Italy
| | - Patrizia Tosi
- Division of Hematology; Ospedale degli Infermi; Rimini Italy
| | - Carmela Tomaselli
- Department of Oncology/Division of Hematology; Ospedale Civico; Palermo Italy
| | - Michele Rizzo
- Division of Hematology; Ospedale S. Elia; Caltanissetta Italy
| | - Sergio Siragusa
- Division of Hematology and Bone Marrow Transplantation; Azienda Ospedaliera Universitaria Policlinico “P. Giaccone,”; Palermo Italy
| | - Miriam Fogli
- Department of Oncology and Hematology; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
- Department of Experimental, Diagnostic and Specialty Medicine; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
| | - Riccardo Ragionieri
- Department of Oncology and Hematology; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
- Department of Experimental, Diagnostic and Specialty Medicine; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
| | - Alessandro Zironi
- Department of Oncology and Hematology; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
- Department of Experimental, Diagnostic and Specialty Medicine; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
| | - Simona Soverini
- Department of Oncology and Hematology; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
- Department of Experimental, Diagnostic and Specialty Medicine; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
| | - Giovanni Martinelli
- Department of Oncology and Hematology; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
- Department of Experimental, Diagnostic and Specialty Medicine; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
| | - Michele Cavo
- Department of Oncology and Hematology; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
- Department of Experimental, Diagnostic and Specialty Medicine; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
| | - Paolo Vigneri
- Unit of Medical Oncology, A.O.U. Policlinico “Vittorio Emanuele,” University of Catania; Catania Italy
| | - Fabio Stagno
- Division of Hematology, A.O.U. Policlinico “Vittorio Emanuele,”; University of Catania; Catania Italy
| | - Gianantonio Rosti
- Department of Oncology and Hematology; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
- Department of Experimental, Diagnostic and Specialty Medicine; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
| | - Michele Baccarani
- Department of Hematology and Oncology “L. and A. Seràgnoli,”; University of Bologna; Bologna Italy
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14
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Rosti G, Castagnetti F, Gugliotta G, Baccarani M. Tyrosine kinase inhibitors in chronic myeloid leukaemia: which, when, for whom? Nat Rev Clin Oncol 2016; 14:141-154. [PMID: 27752053 DOI: 10.1038/nrclinonc.2016.139] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The therapeutic armamentarium for chronic myeloid leukaemia (CML) comprises mainly tyrosine kinase inhibitors (TKIs), with several agents available for frontline treatment, or for the treatment of disease resistance or intolerance to the first-choice or second-choice drug. The availability of different drugs is a major achievement, but means that choices must be made - which can be difficult and questionable at times. The most important end point considered in decision-making regarding treatment for any cancer is overall survival, but additional factors (such as age, prognostic category, safety, or the possibility of achieving treatment-free remission) should be considered when selecting an agent for frontline treatment. Regardless of the TKI selected for first-line treatment, guidelines that define the importance of reaching specific response indicators and procedures for vigilant follow-up monitoring are established to ensure timely implementation of second-line TKIs. Herein, we discuss the benefits and risks of the different TKIs available for the treatment of patients with CML, and how to decide when to employ these agents at different treatment settings.
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Affiliation(s)
- Gianantonio Rosti
- Institute of Haematology and Medical Oncology Lorenzo ed Ariosto Seràgnoli, Department of Experimental, Diagnostic and Specialty Medicine, Bologna University School of Medicine, S.Orsola-Malpighi University Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | - Fausto Castagnetti
- Institute of Haematology and Medical Oncology Lorenzo ed Ariosto Seràgnoli, Department of Experimental, Diagnostic and Specialty Medicine, Bologna University School of Medicine, S.Orsola-Malpighi University Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | - Gabriele Gugliotta
- Institute of Haematology and Medical Oncology Lorenzo ed Ariosto Seràgnoli, Department of Experimental, Diagnostic and Specialty Medicine, Bologna University School of Medicine, S.Orsola-Malpighi University Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | - Michele Baccarani
- Institute of Haematology and Medical Oncology Lorenzo ed Ariosto Seràgnoli, Department of Experimental, Diagnostic and Specialty Medicine, Bologna University School of Medicine, S.Orsola-Malpighi University Hospital, Via Massarenti 9, 40138 Bologna, Italy
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15
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Cervantes F, Correa JG, Pérez I, García-Gutiérrez V, Redondo S, Colomer D, Jiménez-Velasco A, Steegmann JL, Sánchez-Guijo F, Ferrer-Marín F, Pereira A, Osorio S. Imatinib dose reduction in patients with chronic myeloid leukemia in sustained deep molecular response. Ann Hematol 2016; 96:81-85. [DOI: 10.1007/s00277-016-2839-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 09/25/2016] [Indexed: 11/29/2022]
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16
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Yin XF, Wang JH, Li X, Yu MX, Ma ZX, Jin J. Incidence of Second Malignancies of Chronic Myeloid Leukemia During Treatment With Tyrosine Kinase Inhibitors. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 16:577-581. [DOI: 10.1016/j.clml.2016.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 05/20/2016] [Accepted: 06/01/2016] [Indexed: 12/29/2022]
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17
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Faye BF, Dieng N, Seck M, Gadji M, Gueye YB, Sy D, Toure SA, Sall A, Toure AO, Dieye TN, Diop S. Pattern of chronic myeloid leukemia in the imatinib era in a Sub-Saharan African setting. Ann Hematol 2016; 95:1603-10. [PMID: 27370991 DOI: 10.1007/s00277-016-2745-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 06/26/2016] [Indexed: 12/17/2022]
Abstract
Chronic myeloid leukemia (CML) is an orphan disease in Africa because of the inaccessibility to specific treatment and the high cost of diagnosis and monitoring patients. The aim of this study was to report CML treatment response in a developing country in the tyrosine kinase inhibitor era. We conducted a longitudinal study of our cohort of CML patients. Socio-demographic, diagnosis, therapeutic, and treatment response parameters were studied. Sokal score, disease phase at diagnosis, delay from diagnosis to treatment, and treatment response were analyzed for their impact on survival. Fifty-five patients with a diagnosis of CML and who received treatment with imatinib for a minimum of 3 months were included in this study. Median follow-up was 170 patient-years. The sex ratio (M/F) was 1.62 and median age at diagnosis was 42 years. At diagnosis, 85.5 % of the patients were in chronic phase (CP), 12.7 % in accelerated phase (AP), and 1.8 % in blast crisis (BC). Sokal risk score distribution was as follows: low risk 29.8 %, intermediate risk 38.3 %, and high risk 31.9 %. Median time from first symptoms to first medical visit was 6.2 months and median time from first medical visit to cytogenetic and or molecular confirmation was 12.4 months. Mean delay time from first medical visit to imatinib initiation was 12.5 months (95 % CI 6.3-18.7). The complete hematologic response (CHR) at 3 months, the major cytogenetic response (MCR) at 12 months, and the major molecular response (MMR) at 24 months were respectively 82.4, 75, and 25 %. The 2-year overall survival rate was 81 %. Advanced phase at the diagnosis, discontinuation of imatinib therapy over 15 % of the time, lack of CHR at 3 months, lack of MCR at 12 months, and progression of the disease during imatinib therapy were associated with a risk of death (p ≤ 0.05). Our data confirm the improved prognosis of CML treated with imatinib in the setting of a developing country. However, response rates are lower than in developed countries, and additional efforts should be made to facilitate early diagnosis and improve access to TKI, treatment compliance, and regular molecular monitoring of patients.
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MESH Headings
- Adolescent
- Adult
- Aged
- Antineoplastic Agents/therapeutic use
- Child
- Cost of Illness
- Delayed Diagnosis
- Developing Countries
- Disease Management
- Female
- Follow-Up Studies
- Humans
- Imatinib Mesylate/therapeutic use
- Kaplan-Meier Estimate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/economics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/epidemiology
- Male
- Middle Aged
- Molecular Targeted Therapy
- Neoplasm Proteins/antagonists & inhibitors
- Protein Kinase Inhibitors/therapeutic use
- Senegal/epidemiology
- Socioeconomic Factors
- Treatment Outcome
- Young Adult
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Affiliation(s)
| | - Nata Dieng
- Hematology, Cheikh Anta Diop University, BP 5005, Dakar, Senegal
| | - Moussa Seck
- Hematology, Cheikh Anta Diop University, BP 5005, Dakar, Senegal
| | - Macoura Gadji
- Hematology, Cheikh Anta Diop University, BP 5005, Dakar, Senegal
| | | | - Diariatou Sy
- Hematology, Cheikh Anta Diop University, BP 5005, Dakar, Senegal
| | | | - Abibatou Sall
- Hematology, Cheikh Anta Diop University, BP 5005, Dakar, Senegal
| | - Awa Oumar Toure
- Hematology, Cheikh Anta Diop University, BP 5005, Dakar, Senegal
| | | | - Saliou Diop
- Hematology, Cheikh Anta Diop University, BP 5005, Dakar, Senegal.
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18
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Gugliotta G, Castagnetti F, Breccia M, Gozzini A, Usala E, Carella AM, Rege-Cambrin G, Martino B, Abruzzese E, Albano F, Stagno F, Luciano L, D'Adda M, Bocchia M, Cavazzini F, Tiribelli M, Lunghi M, Pia Falcone A, Musolino C, Levato L, Venturi C, Soverini S, Cavo M, Alimena G, Pane F, Martinelli G, Saglio G, Rosti G, Baccarani M. Rotation of nilotinib and imatinib for first-line treatment of chronic phase chronic myeloid leukemia. Am J Hematol 2016; 91:617-22. [PMID: 26971721 DOI: 10.1002/ajh.24362] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 03/04/2016] [Accepted: 03/08/2016] [Indexed: 12/16/2022]
Abstract
The introduction of second-generation tyrosine-kinase inhibitors (TKIs) has generated a lively debate on the choice of first-line TKI in chronic phase, chronic myeloid leukemia (CML). Despite the TKIs have different efficacy and toxicity profiles, the planned use of two TKIs has never been investigated. We report on a phase 2 study that was designed to evaluate efficacy and safety of a treatment alternating nilotinib and imatinib, in newly diagnosed BCR-ABL1 positive, chronic phase, CML patients. One hundred twenty-three patients were enrolled. Median age was 56 years. The probabilities of achieving a complete cytogenetic response, a major molecular response, and a deep molecular response (MR 4.0) by 2 years were 93%, 87%, and 61%, respectively. The 5-year overall survival and progression-free survival were 89%. Response rates and survival are in the range of those reported with nilotinib alone. Moreover, we observed a relatively low rate of cardiovascular adverse events (5%). These data show that the different efficacy and toxicity profiles of TKIs could be favorably exploited by alternating their use. Am. J. Hematol. 91:617-622, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Gabriele Gugliotta
- Institute of Hematology “L. and A. Seràgnoli”, Department of Experimental Diagnostic and Specialty Medicine, “S. Orsola-Malpighi” Hospital, University of Bologna; Bologna Italy
| | - Fausto Castagnetti
- Institute of Hematology “L. and A. Seràgnoli”, Department of Experimental Diagnostic and Specialty Medicine, “S. Orsola-Malpighi” Hospital, University of Bologna; Bologna Italy
| | | | - Antonella Gozzini
- Chair of Hematology, “Careggi” Hospital, University of Florence; Florence Italy
| | - Emilio Usala
- Hematology Unit, “A. Businco” Hospital; Cagliari Italy
| | - Angelo M. Carella
- IRCCS AOU San Martino-IST, Hematology and Bone Marrow Transplantation Unit; Genova Italy
| | - Giovanna Rege-Cambrin
- Chair of Hematology; Department of Clinical and Biological Sciences; “S. Luigi Gonzaga” University Hospital, University of Torino; Orbassano (Torino) Italy
| | - Bruno Martino
- Hematology Unit, “Bianchi-Melacrino-Morelli” Hospital; Reggio Calabria Italy
| | | | - Francesco Albano
- Chair of Hematology; Department of Emergency and Organ Transplantation; University of Bari; Bari Italy
| | - Fabio Stagno
- Chair of Hematology, “Ferrarotto” Hospital, University of Catania; Catania Italy
| | - Luigia Luciano
- Chair of Hematology; Department of Biochemistry and Medical Biotechnologies; “Federico II” University; Naples Italy
| | | | - Monica Bocchia
- Chair of Hematology; “S.Maria alle Scotte” Hospital, Siena, Italy, University of Siena
| | - Francesco Cavazzini
- Chair of Hematology; “S. Anna” Hospital, University of Ferrara; Ferrara Italy
| | | | - Monia Lunghi
- Chair of Hematology; “A. Avogadro” University of Eastern Piedmont; Novara Italy
| | - Antonietta Pia Falcone
- Hematology Unit; IRCCS “Ospedale Casa Sollievo della Sofferenza”; S.Giovanni Rotondo Italy
| | | | - Luciano Levato
- Hematology Unit; “Pugliese-Ciaccio” Hospital; Catanzaro Italy
| | - Claudia Venturi
- Institute of Hematology “L. and A. Seràgnoli”, Department of Experimental Diagnostic and Specialty Medicine, “S. Orsola-Malpighi” Hospital, University of Bologna; Bologna Italy
| | - Simona Soverini
- Institute of Hematology “L. and A. Seràgnoli”, Department of Experimental Diagnostic and Specialty Medicine, “S. Orsola-Malpighi” Hospital, University of Bologna; Bologna Italy
| | - Michele Cavo
- Institute of Hematology “L. and A. Seràgnoli”, Department of Experimental Diagnostic and Specialty Medicine, “S. Orsola-Malpighi” Hospital, University of Bologna; Bologna Italy
| | | | - Fabrizio Pane
- Chair of Hematology; Department of Biochemistry and Medical Biotechnologies; “Federico II” University; Naples Italy
| | - Giovanni Martinelli
- Institute of Hematology “L. and A. Seràgnoli”, Department of Experimental Diagnostic and Specialty Medicine, “S. Orsola-Malpighi” Hospital, University of Bologna; Bologna Italy
| | - Giuseppe Saglio
- Chair of Hematology; Department of Clinical and Biological Sciences; “S. Luigi Gonzaga” University Hospital, University of Torino; Orbassano (Torino) Italy
| | - Gianantonio Rosti
- Institute of Hematology “L. and A. Seràgnoli”, Department of Experimental Diagnostic and Specialty Medicine, “S. Orsola-Malpighi” Hospital, University of Bologna; Bologna Italy
| | - Michele Baccarani
- Department of Hematology and Oncology “L. and A. Seràgnoli”; University of Bologna; Bologna Italy
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Bourlon C, Hernandez-Mata C, Vargas-Serafín C, Bourlon MT, Tuna-Aguilar E, Aguayo A. Fluorescent In Situ Hybridization Monitoring and Effect of Detected Early Responses in the Outcome of Patients With Chronic Phase Chronic Myeloid Leukemia: A Report From a Latin American Country. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 16:453-9. [PMID: 27259590 DOI: 10.1016/j.clml.2016.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 04/15/2016] [Accepted: 04/26/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The cytogenetic hallmark of chronic myeloid leukemia (CML) is the Philadelphia chromosome. Monitoring the response in patients receiving therapy is a standard of care. The present study was conducted to assess the monitoring adherence and reliableness of fluorescent in situ hybridization (FISH) as a monitoring tool and the effect of a complete cytogenetic response (CCyR) assessed by FISH on the prognosis of patients in a chronic phase (CP)-CML cohort. MATERIALS AND METHODS We retrospectively analyzed the data from 63 newly diagnosed CP-CML patients treated with imatinib mesylate at a dose of 400 mg/day as frontline therapy. The clinical data and cytogenetic test results at diagnosis and during monitoring were collected. The cytogenetic monitoring adherence assessment rates were measured. A correlation between chromosome banding analysis (CBA) and FISH was performed. The CCyR assessed by FISH was defined as < 1% BCR-ABL1(+) nuclei. The Kaplan-Meier method was used for overall survival analysis and time-to-event estimates. RESULTS The cytogenetic monitoring assessment adherence was 50.8% at 3 months, 93.5% at 6 months, 96.7% at 12 months, and 88.6% at 18 months. The Pearson correlation coefficient showed a significantly positive association (r = 0.84; P < .001) between CBA and FISH. The median follow-up duration after imatinib mesylate initiation was 60 months. A CCyR was achieved in 90.4% of patients within the first 18 months of therapy. At 3 months, 31 patients underwent a FISH evaluation, and 13 (41.9%) had achieved a CCyR. The patients who did not achieve a CCyR at 3 months had a significantly inferior probability of 5-year failure-free survival (38% vs. 94%; P = .001) and progression-free survival (80% vs. 100%; P = .043) compared with those with a CCyR. CONCLUSION We found improved monitoring adherence compared with the previous reports of Latin American populations. In countries with a high incidence of failure for CBA and a lack of real-time polymerase chain reaction standardization, FISH is a sensitive monitoring tool. In our cohort, patients not achieving an early CCyR, as tested by FISH, were a poor prognosis subgroup with worse rates of failure-free survival and progression-free survival.
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Affiliation(s)
- Christianne Bourlon
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, México
| | - Carlos Hernandez-Mata
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, México
| | - Cesar Vargas-Serafín
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, México
| | - María T Bourlon
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, México
| | - Elena Tuna-Aguilar
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, México
| | - Alvaro Aguayo
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, México.
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20
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Sissolak G, Badenhorst J, Steenkamp J, Heaney M, Louw V, Schnugh D, Willem P. Treatment Outcomes in CML Patients Treated With Tyrosine Kinase Inhibitors at a Tertiary Teaching Hospital in South Africa. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:803-10. [PMID: 26481837 DOI: 10.1016/j.clml.2015.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/04/2015] [Accepted: 09/11/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND Chronic myeloid leukemia (CML) has become one of the most treatable hematologic neoplasms since the advent of the tyrosine kinase inhibitors (TKIs), but it was not known if similar treatment outcomes could be achieved in a resource-limited country. We tested the hypothesis that, despite challenges to access to second-generation TKIs, excellent responses could be replicated in the setting of limited resources. PATIENTS AND METHODS Records of 58 patients with newly diagnosed CML in the chronic phase treated with TKIs at a tertiary teaching hospital in Cape Town, South Africa between 2003 and 2012 were reviewed and assessed according to European LeukemiaNet (ELN) criteria. RESULTS After a median follow-up of 60.5 months, progression-free survival at 60 and 96 months was 79.98% and 68.4%, respectively. Overall survival at 60 and 96 months was 92.9% and 83.6%, respectively. Progression to blast phase at 60 months was associated with poorer survival (P = .0002) but progression to accelerated phase was not (P = .1456). Attainment of a complete cytogenetic response at 12 months (P = .28) or major molecular response at 18 months (P = .268) did not have prognostic significance. CONCLUSION Despite delays in achievement of the target responses defined according to ELN criteria, the use of imatinib mesylate as a first-line treatment can still result in treatment outcomes comparable with those in developed countries. These data suggest opportunities for improvement and success might be even greater with uninterrupted access to second-generation or newer TKIs.
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Affiliation(s)
- Gerhard Sissolak
- Department of Internal Medicine, Tygerberg Academic Hospital, University of Stellenbosch, Cape Town, South Africa.
| | - Jacques Badenhorst
- Department of Internal Medicine, Tygerberg Academic Hospital, University of Stellenbosch, Cape Town, South Africa
| | - Janami Steenkamp
- Department of Pathology, National Health Laboratory Services (NHLS), University of Stellenbosch and Pathcare Laboratories, Cape Town, South Africa
| | - Mark Heaney
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Vernon Louw
- Department of Medicine, University of the Free State, Bloemfontein and Panorama Mediclinic, Cape Town, South Africa
| | - Desmond Schnugh
- Department of Haematology and Molecular Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Pascale Willem
- Department of Haematology and Molecular Medicine, University of the Witwatersrand, Johannesburg, South Africa
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21
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Pfirrmann M, Baccarani M, Saussele S, Guilhot J, Cervantes F, Ossenkoppele G, Hoffmann VS, Castagnetti F, Hasford J, Hehlmann R, Simonsson B. Prognosis of long-term survival considering disease-specific death in patients with chronic myeloid leukemia. Leukemia 2015; 30:48-56. [PMID: 26416462 DOI: 10.1038/leu.2015.261] [Citation(s) in RCA: 179] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 09/14/2015] [Indexed: 02/06/2023]
Abstract
In patients with chronic myeloid leukemia (CML), first-line imatinib treatment leads to 8-year overall survival (OS) probabilities above 80%. Many patients die of reasons unrelated to CML. This work tackled the reassessment of prognosis under particular consideration of the probabilities of dying of CML. Analyses were based on 2290 patients with chronic phase CML treated with imatinib in six clinical trials. 'Death due to CML' was defined by death after disease progression. At 8 years, OS was 89%. Of 208 deceased patients, 44% died of CML. Higher age, more peripheral blasts, bigger spleen and low platelet counts were significantly associated with increased probabilities of dying of CML and determined a new long-term survival score with three prognostic groups. Compared with the low-risk group, the patients of the intermediate- and the high-risk group had significantly higher probabilities of dying of CML. The score was successfully validated in an independent sample of 1120 patients. In both samples, the new score differentiated probabilities of dying of CML better than the Sokal, Euro and the European Treatment and Outcome Study (EUTOS) score. The new score identified 61% low-risk patients with excellent long-term outcome and 12% high-risk patients. The new score supports the prospective assessment of long-term antileukemic efficacy and risk-adapted treatment.
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Affiliation(s)
- M Pfirrmann
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians Universität, München, Germany
| | - M Baccarani
- Hematology and Oncology L and A Seragnoli, S Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - S Saussele
- III. Medizinische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - J Guilhot
- Clinical Investigation Centre-INSERM CIC 1402, CHU Poitiers, Poitiers, France
| | - F Cervantes
- Hematology Department, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - G Ossenkoppele
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - V S Hoffmann
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians Universität, München, Germany
| | - F Castagnetti
- Hematology and Oncology L and A Seragnoli, S Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - J Hasford
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians Universität, München, Germany
| | - R Hehlmann
- III. Medizinische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
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22
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Kottwitz D, El Hadi H, El Amrani M, Cabezas S, Dehbi H, Nadifi S, Quessar A, Colomer D, Moumen A, Sefrioui ELH. Evaluation of a novel multiplex RT-qPCR assay for the quantification of leukemia-associated BCR-ABL1 translocation. Int J Hematol 2015; 102:335-41. [PMID: 26243622 DOI: 10.1007/s12185-015-1839-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 06/30/2015] [Accepted: 07/07/2015] [Indexed: 11/25/2022]
Abstract
Although monitoring of BCR-ABL1 translocation has become an established practice in the management of chronic myeloid leukemia (CML), the detection limit of the BCR-ABL1 transcripts needs more standardization. The aim of the present study was to evaluate the clinical performances of a novel assay for the quantification of BCR-ABL1 fusion transcripts (e13a2 and e14a2) and ABL1 in a single reaction. This assay is based on the real-time reverse transcription polymerase chain reaction (RT-qPCR) in multiplex format. In a retrospective comparative clinical study performed in a reference laboratory, RNA was extracted from 48 CML patient blood samples with various BCR-ABL1/ABL1 ratios and RT-qPCR was performed using either MAScIR assay or the RT-qPCR simplex reference assay used in routine clinical testing. The comparative clinical results showed high qualitative and quantitative concordance (correlation coefficient >0.95) between MAScIR and the reference assays. The present study illustrates the utility of MAScIR assay as a sensitive, rapid, and cost-effective quantitative device to monitor the BCR-ABL1 ratios by RT-qPCR on whole blood of diagnosed Philadelphia chromosome-positive (Ph+) leukemia patients. This test could be used as an aid in the assessment of molecular response to available treatments.
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MESH Headings
- Female
- Fusion Proteins, bcr-abl/blood
- Fusion Proteins, bcr-abl/genetics
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Male
- Multiplex Polymerase Chain Reaction/methods
- Philadelphia Chromosome
- RNA, Messenger/blood
- RNA, Messenger/genetics
- Retrospective Studies
- Reverse Transcriptase Polymerase Chain Reaction/methods
- Translocation, Genetic
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Affiliation(s)
- D Kottwitz
- MAScIR: Moroccan Foundation for Advanced Sciences, Innovation and Research, Medical Biotechnology Center, Rabat Design, Rue Mohamed El Jazouli, Madinat Al Irfane, 10100, Rabat, Morocco
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23
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Gugliotta G, Castagnetti F, Breccia M, Levato L, D'Adda M, Stagno F, Tiribelli M, Salvucci M, Fava C, Martino B, Cedrone M, Bocchia M, Trabacchi E, Cavazzini F, Usala E, Russo Rossi A, Bochicchio MT, Soverini S, Alimena G, Cavo M, Pane F, Martinelli G, Saglio G, Baccarani M, Rosti G. Long-term outcome of a phase 2 trial with nilotinib 400 mg twice daily in first-line treatment of chronic myeloid leukemia. Haematologica 2015; 100:1146-50. [PMID: 26113419 DOI: 10.3324/haematol.2015.129221] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 06/23/2015] [Indexed: 12/24/2022] Open
Abstract
Nilotinib is a second-generation tyrosine kinase inhibitor that has been approved for the first-line treatment of chronic-phase chronic myeloid leukemia, based on the results of a prospective randomized study of nilotinib versus imatinib (ENESTnd). Apart from this registration study, very few data are currently available on first-line nilotinib treatment. We report here the long-term, 6-year results of the first investigator-sponsored, GIMEMA multicenter phase 2, single-arm trial with nilotinib 400 mg twice daily as first-line treatment in 73 patients with chronic-phase chronic myeloid leukemia. Six-year overall survival and progression-free survival rates were 96%, with one death after progression to blast phase. At 6 years, 75% of the patients were still on nilotinib. The cumulative incidence of major molecular response was 98%; only one patient had a confirmed loss of major molecular response. The cumulative incidence of deep molecular response (MR 4.0) was 76%. Deep molecular response was stable (≥ 2 years) in 34% of these patients. Cardiovascular adverse events, mainly due to arterial thrombosis, occurred in 11/73 patients (15%), after 24 to 76 months of therapy. They were more frequent in elderly patients, and in those with baseline cardiovascular risk factors. None was fatal, although there was a relevant morbidity. This is the study with the longest follow-up of a high dose of nilotinib (400 mg twice daily): it highlights the high efficacy and the cardiovascular toxicity of the drug (CTG.NCT.00481052).
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Affiliation(s)
- Gabriele Gugliotta
- Institute of Hematology "L. and A. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine, "S. Orsola-Malpighi" University Hospital, University of Bologna, Roma, Italy
| | - Fausto Castagnetti
- Institute of Hematology "L. and A. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine, "S. Orsola-Malpighi" University Hospital, University of Bologna, Roma, Italy
| | | | - Luciano Levato
- Hematology Unit, "Pugliese-Ciaccio" Hospital, Catanzaro, Italy
| | - Mariella D'Adda
- Hematology Unit, "Spedali Civili" Hospital, Brescia, Ravenna, Italy
| | - Fabio Stagno
- Chair of Hematology, University of Catania, Ravenna, Italy
| | | | - Marzia Salvucci
- Hematology Unit, "S. Maria delle Croci" Hospital, Ravenna, Italy
| | - Carmen Fava
- Chair of Hematology, Department of Clinical and Biological Sciences, "S. Luigi Gonzaga" University Hospital, University of Torino, Orbassano, Italy
| | - Bruno Martino
- Hematology Unit, "Bianchi-Melacrino-Morelli" Hospital, Reggio Calabria, Italy
| | - Michele Cedrone
- Hematology Unit, "S. Giovanni Addolorata" Hospital, Roma, Italy
| | - Monica Bocchia
- Chair of Hematology, "S. Maria alle Scotte" Hospital, University of Siena, Piacenza, Italy
| | - Elena Trabacchi
- Hematology Unit, "Guglielmo da Saliceto" Hospital, Piacenza, Italy
| | - Francesco Cavazzini
- Chair of Hematology, "S. Anna" University Hospital, University of Ferrara, Cagliari, Italy
| | - Emilio Usala
- Hematology Unit, "A. Businco" Hospital, Cagliari, Italy
| | | | - Maria Teresa Bochicchio
- Institute of Hematology "L. and A. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine, "S. Orsola-Malpighi" University Hospital, University of Bologna, Roma, Italy
| | - Simona Soverini
- Institute of Hematology "L. and A. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine, "S. Orsola-Malpighi" University Hospital, University of Bologna, Roma, Italy
| | | | - Michele Cavo
- Institute of Hematology "L. and A. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine, "S. Orsola-Malpighi" University Hospital, University of Bologna, Roma, Italy
| | - Fabrizio Pane
- Chair of Hematology, Department of Biochemistry and Medical Biotechnologies, "Federico II" University, Napoli, Italy
| | - Giovanni Martinelli
- Institute of Hematology "L. and A. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine, "S. Orsola-Malpighi" University Hospital, University of Bologna, Roma, Italy
| | - Giuseppe Saglio
- Chair of Hematology, Department of Clinical and Biological Sciences, "S. Luigi Gonzaga" University Hospital, University of Torino, Orbassano, Italy
| | - Michele Baccarani
- Department of Hematology and Oncology "L. and A. Seràgnoli", University of Bologna, Italy
| | - Gianantonio Rosti
- Institute of Hematology "L. and A. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine, "S. Orsola-Malpighi" University Hospital, University of Bologna, Roma, Italy
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24
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Castagnetti F, Gugliotta G, Breccia M, Stagno F, Iurlo A, Albano F, Abruzzese E, Martino B, Levato L, Intermesoli T, Pregno P, Rossi G, Gherlinzoni F, Leoni P, Cavazzini F, Venturi C, Soverini S, Testoni N, Alimena G, Cavo M, Martinelli G, Pane F, Saglio G, Rosti G, Baccarani M. Long-term outcome of chronic myeloid leukemia patients treated frontline with imatinib. Leukemia 2015; 29:1823-31. [PMID: 26088952 DOI: 10.1038/leu.2015.152] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 05/20/2015] [Accepted: 05/29/2015] [Indexed: 01/08/2023]
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.
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Affiliation(s)
- F Castagnetti
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L and A Seràgnoli', University of Bologna, 'S Orsola-Malpighi' University Hospital, Bologna, Italy
| | - G Gugliotta
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L and A Seràgnoli', University of Bologna, 'S Orsola-Malpighi' University Hospital, Bologna, Italy
| | - M Breccia
- Chair of Hematology, 'La Sapienza' University, Roma, Italy
| | - F Stagno
- Chair of Hematology, University of Catania, Catania, Italy
| | - A Iurlo
- Oncohematology of the Elderly Unit, Oncohematology Division, IRCCS Ca' Granda - Maggiore University Hospital, Milano, Italy
| | - F Albano
- Chair of Hematology, University of Bari, Bari, Italy
| | - E Abruzzese
- Hematology Unit, 'S Eugenio' Hospital, Roma, Italy
| | - B Martino
- Hematology Unit, Azienda Ospedaliera 'Bianchi-Melacrino-Morelli', Reggio Calabria, Italy
| | - L Levato
- Hematology Unit, 'Pugliese-Ciaccio' Hospital, Catanzaro, Italy
| | - T Intermesoli
- Hematology Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - P Pregno
- Hematology Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino, Italy
| | - G Rossi
- Hematology Unit, Azienda Ospedaliera 'Spedali Civili', Brescia, Italy
| | - F Gherlinzoni
- Hematology Unit, 'Ca' Foncello' Hospital, Treviso, Italy
| | - P Leoni
- Chair of Hematology, Torrette University Hospital, Ancona, Italy
| | - F Cavazzini
- Chair of Hematology, Azienda Ospedaliero Universitaria Arcispedale S Anna, University of Ferrara, Ferrara, Italy
| | - C Venturi
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L and A Seràgnoli', University of Bologna, 'S Orsola-Malpighi' University Hospital, Bologna, Italy
| | - S Soverini
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L and A Seràgnoli', University of Bologna, 'S Orsola-Malpighi' University Hospital, Bologna, Italy
| | - N Testoni
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L and A Seràgnoli', University of Bologna, 'S Orsola-Malpighi' University Hospital, Bologna, Italy
| | - G Alimena
- Chair of Hematology, 'La Sapienza' University, Roma, Italy
| | - M Cavo
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L and A Seràgnoli', University of Bologna, 'S Orsola-Malpighi' University Hospital, Bologna, Italy
| | - G Martinelli
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L and A Seràgnoli', University of Bologna, 'S Orsola-Malpighi' University Hospital, Bologna, Italy
| | - F Pane
- Department of Biochemistry and Medical Biotechnologies, 'Federico II' University, Napoli, Italy
| | - G Saglio
- Chair of Hematology, Department of Clinical and Biological Sciences, 'S Luigi Gonzaga' University Hospital, University of Torino, Orbassano (TO), Italy
| | - G Rosti
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L and A Seràgnoli', University of Bologna, 'S Orsola-Malpighi' University Hospital, Bologna, Italy
| | - M Baccarani
- Department of Hematology and Oncology 'L and A Seràgnoli', University of Bologna, Bologna, Italy
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25
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Park JS, Lee SE, Jeong SH, Jang EJ, Choi MY, Kim HJ, Kim YK, Kim SH, Zang DY, Oh S, Koo DH, Kim H, Do YR, Kwak JY, Kim JA, Kim DY, Mun YC, Lee WS, Chang MH, Park J, Kwon JH, Kim DW. Change of health-related profiles after Imatinib cessation in chronic phase chronic myeloid leukemia patients. Leuk Lymphoma 2015; 57:341-347. [PMID: 25947037 DOI: 10.3109/10428194.2015.1049166] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this study was to investigate the changes in health-related profiles including quality-of-life (HRQoL) in the chronic myeloid leukemia (CML) patients who discontinued imatinib (IM). An HRQoL survey composed of 43 parameters about IM-related adverse events (AEs), physical health-related and mental health-related was provided at baseline and 6 months post-discontinuation. A total of 55 patients with a sustained UMRD over 6 months were analyzed. Although the majority of IM-related AEs were significantly improved, unexpectedly pruritus and musculoskeletal pain worsen or newly develop in 29.1% and 21.8% of patients, respectively. The improvements in physical and mental health condition were variable in individual patients. In addition, rapid restorations of the hematological and biochemical parameters were observed. The results showed the changes of HRQoL and laboratory tests in treatment-off patients and the necessity of continuing physical and mental support for some patients in tyrosine kinase inhibitor (TKI)-off studies.
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Affiliation(s)
- Joon Seong Park
- a Department of Hematology-Oncology , Ajou University School of Medicine , Suwon , Korea
| | - Sung-Eun Lee
- b Department of Hematology , Seoul St Mary's Hospital, The Catholic University of Korea , Seoul , Korea
| | - Seong Hyun Jeong
- a Department of Hematology-Oncology , Ajou University School of Medicine , Suwon , Korea
| | - Eun-Jung Jang
- b Department of Hematology , Seoul St Mary's Hospital, The Catholic University of Korea , Seoul , Korea
| | - Mi-Yeon Choi
- b Department of Hematology , Seoul St Mary's Hospital, The Catholic University of Korea , Seoul , Korea
| | - Hyeoung-Joon Kim
- c Department of Hematology-Oncology , Chonnam National University Hwasun, Hospital , Hwasun , Korea
| | - Yeo-Kyeoung Kim
- c Department of Hematology-Oncology , Chonnam National University Hwasun, Hospital , Hwasun , Korea
| | - Sung-Hyun Kim
- d Department of Internal Medicine , Dong-A University College of Medicine , Busan , Korea
| | - Dae Young Zang
- e Department of Internal Medicine , Hallym University College of Medicine , Anyang , Korea
| | - Sukjoong Oh
- f Division of Hematology-Oncology, Department of Internal Medicine , Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University , Seoul , Korea
| | - Dong Hoe Koo
- f Division of Hematology-Oncology, Department of Internal Medicine , Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University , Seoul , Korea
| | - Hawk Kim
- g Division of Hematology and Cellular Therapy, Ulsan University Hospital, University of Ulsan College of Medicine , Ulsan , Korea
| | - Young Rok Do
- h Division of Hematology-Oncology, School of Medicine, Keimyung University , Daegu , Korea
| | - Jae-Yong Kwak
- i Division of Hematology-Oncology, Chonbuk National University Medical School , Jeonju , Korea
| | - Jeong-A Kim
- j Department of Hematology , St Vincent's Hospital, The Catholic University of Korea , Suwon , Korea
| | - Dae-Young Kim
- k Department of Hematology , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Korea
| | - Yeung-Chul Mun
- l Department of Hematology , School of Medicine, Ewha Womans University , Seoul , Korea
| | - Won Sik Lee
- m Department of Internal Medicine , Inje University College of Medicine, Inje University Busan Paik Hospital , Busan , Korea
| | - Myung Hee Chang
- n Department of Hematology-Oncology , National Health Insurance Service Ilsan Hospital , Ilsan , Korea
| | - Jinny Park
- o Department of Hematology , Gachon University Gil Hospital , Incheon , Korea
| | - Ji Hyun Kwon
- p Department of Hematology-Oncology , Chungbuk National University Hospital , Cheongju , Korea
| | - Dong-Wook Kim
- b Department of Hematology , Seoul St Mary's Hospital, The Catholic University of Korea , Seoul , Korea
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26
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Edesa WA, Abdel-malek RR. Impact of imatinib interruption and duration of prior hydroxyurea on the treatment outcome in patients with chronic myeloid leukemia: Single institution experience. J Egypt Natl Canc Inst 2015; 27:69-75. [PMID: 25882857 DOI: 10.1016/j.jnci.2015.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 03/14/2015] [Accepted: 03/21/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Optimal response requires that patients should be maintained on the drug continuously. OBJECTIVES To evaluate the influence of imatinib interruption and prior hydroxyurea use on the outcome of patients with chronic myeloid leukemia. MATERIALS AND METHODS Between January 2010 and November 2013, patients with chronic phase who received imatinib at the Kasr Al-ainy Center of Clinical Oncology were included. RESULTS Sixty patients were included in this study, thirty three patients (55%) received imatinib upfront, while 27 (45%) received imatinib post hydroxyurea. Imatinib was not given regularly in 50% of patients. In terms of response, only major molecular response and complete molecular response were statistically significant in favor of patients who were receiving imatinib regularly compared to those who had interruption (p<0.001, p<0.001, respectively) , while there was no difference in patients stratified according to prior hydroxyurea. The median progression free survival was 30.3 months (95% CI 24.3-36.3). Among the group of patients who received imatinib regularly, progression free survival was longer (p=0.049), there was no difference between those who received prior hydroxyurea versus those who did not (p=0.67). CONCLUSION Duration of prior hydroxyurea had no impact on response or progression free survival, while patients regular on imatinib had statistically significant difference with respect to major molecular response, complete molecular response and progression free survival compared to those who had periods of drug interruption, thus we need more governmental support to supply the drug without interruption to improve the outcome of therapy.
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27
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Baccarani M, Castagnetti F, Gugliotta G, Rosti G. A review of the European LeukemiaNet recommendations for the management of CML. Ann Hematol 2015; 94 Suppl 2:S141-7. [PMID: 25814080 DOI: 10.1007/s00277-015-2322-2] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 01/27/2015] [Indexed: 10/23/2022]
Abstract
Several guidelines and recommendations on the management of chronic myeloid leukemia (CML) have been prepared by several scientific societies. The European LeukemiaNet (ELN) appointed a panel of experts who submitted their recommendations to peer-reviewed scientific journals in 2006, 2009, and 2013. Here, we make a critical review of the last, 2013, ELN recommendations, concerning the use of the five available tyrosine kinase inhibitors (TKIs), the evaluation of cytogenetic and molecular response, and the strategy of treatment. Three TKIs (imatinib, nilotinib, dasatinib) are recommended first-line. Bosutinib and ponatinib are available second-line; ponatinib is particularly indicated in case of the T315I mutation. Achieving an optimal response, not only for survival but also for a deeper, stable, treatment-free remission, requires a BCR-ABL transcripts level ≤ 10 % at 3 months, ≤ 1 % at 6 months, ≤ 0.1 % at 1 year, and ≤ 0.01 % later on. Molecular monitoring must include mutational analysis in every case of failure. A successful treatment of accelerated and blastic phase requires TKIs, and in many cases also allogeneic stem cell transplantation.
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Affiliation(s)
- Michele Baccarani
- Department of Hematology and Oncology "L. and A. Seràgnoli", University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
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28
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Hehlmann R. CML—where do we stand in 2015? Ann Hematol 2015; 94 Suppl 2:S103-5. [DOI: 10.1007/s00277-015-2331-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 01/28/2015] [Indexed: 10/23/2022]
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Outcome prediction by the transcript level of BCR-ABL at 3 months in patients with chronic myeloid leukemia treated with imatinib-a single institution historical experience. Leuk Res 2014; 38:1191-8. [DOI: 10.1016/j.leukres.2014.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 07/04/2014] [Accepted: 07/14/2014] [Indexed: 11/18/2022]
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30
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Ali MD, Badi AI, Al-Zebari SSM, Al-Allawi NAS. Response to tyrosine kinase inhibitors in chronic myeloid leukemia: experience from a west Asian developing country. Int J Hematol 2014; 100:274-80. [PMID: 25085252 DOI: 10.1007/s12185-014-1627-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 06/30/2014] [Accepted: 07/01/2014] [Indexed: 11/30/2022]
Abstract
Tyrosine Kinase inhibitors (TKIs) have dramatically changed the prospects for patients with chronic myeloid leukemia (CML); however, information on CML and response to TKIs from Asia are limited, particularly from West Asia, including Iraq. To address the latter issue we evaluated and monitored a cohort of 108 Iraqi patients diagnosed as chronic phase-CML, enrolled in a government-sponsored national program. The patients were all treated initially by imatinib mesylate. Ninety-two percent of patients had a complete hematological response, 38% had a major molecular response, while 79% had a major cytogenetic response after a median follow-up of 35.7 months. The 3-year Event-Free, Progression-Free, and Overall survival rates were 79.6, 87 and 98.1%, respectively. A total of 26 patients (24.1%) were shifted to an alternative TKI (Nilotinib). After one year of therapy in seventeen of the latter patients, 24% had major molecular response. In conclusion, our results compare favorably with those reported from the West and some Asian countries, and have demonstrated the importance of molecular as well as cytogenetic monitoring, and confirmed the relative success of the national CML program in our country.
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31
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Baccarani M, Castagnetti F, Gugliotta G, Palandri F, Rosti G. Definition and treatment of resistance to tyrosine kinase inhibitors in chronic myeloid leukemia. Expert Rev Hematol 2014; 7:397-406. [PMID: 24665926 DOI: 10.1586/17474086.2014.900432] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Resistance to tyrosine kinase inhibitors (TKIs) has many facets. The causes of resistance include low patient compliance, low plasma or intracellular drug concentration, BCR-ABL1 mutations, and clonal chromosome abnormalities in Ph+ cells, but in at least 50% of patients the causes are currently unknown. Primary resistance occurs when a predefined response level is not achieved within a prespecified period of time. Not achieving a complete hematologic response (CHR) within 3 months, not achieving a partial cytogenetic response and/or a BCR-ABL1 transcripts level ≤10% (international standard) within 6 months, and not achieving a complete cytogenetic response (CCyR) and/or a BCR-ABL1 transcripts level <1% within 12 months, define primary resistance. Secondary resistance is defined by a loss of CHR, or CCyR, or major molecular response. Resistance to imatinib calls without exceptions for a second-generation TKI. In case of resistance to two TKIs, an allogeneic stem cell transplantation should be considered.
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Affiliation(s)
- Michele Baccarani
- Department of Hematology and Oncology "L. and A. Seràgnoli", Bologna, Italy
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32
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Imatinib in chronic myeloid leukemia: an overview. Mediterr J Hematol Infect Dis 2014; 6:e2014007. [PMID: 24455116 PMCID: PMC3894842 DOI: 10.4084/mjhid.2014.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 12/02/2013] [Indexed: 12/31/2022] Open
Abstract
Imatinib was the first signal transduction inhibitor (STI), used in a clinical setting. It prevents a BCR-ABL protein from exerting its role in the oncogenic pathway in chronic myeloid leukemia (CML). Imatinib directly inhibits the constitutive tyrosine kinase activity. Imatinib binds to BCR-ABL kinase domain by preventing the transfer of a phosphate group to tyrosine on the protein substrate and the subsequent activation of phosphorylated protein. As the result, the transmission of proliferative signals to the nucleus is blocked and leukemic cell apoptosis is induced. The FDA has approved imatinib as first-line treatment for newly diagnosed CML in December 2002 following an International Randomized Study (IRIS), initiated in June 2000, comparing imatinib at a single daily dose 400 mg to IFN alpha plus cytarabine in newly diagnosed patients with CML in CP. Results from this study show the outstanding effectiveness of imatinib and its superiority with respect to the rates of complete hematological response (CHR), major and complete cytogenetic response (MCyR, CCyR). Patients randomized to imatinib arm at 8 – year data cut off continue to have a durable hematologic and cytogenetic responses, low progression rates to AP or BC, and remarkable survival outcomes. An overall survival (OS) rate is 85% for patients receiving imatinib (93% when only CML-related deaths and those prior to stem cell transplantation are considered). The results have been confirmed in the last years by several groups. According these cumulative results the rates of CCyR achieved after one year of therapy with imatinib at standard dose ranged from 49% to 77%, and the proportion of patients who achieved major molecular response (MMR) after one year ranged between 18% and 58%. Discontinuation of imatinib has been also tried in patients in MMR, a molecular relapse occurs in about one third of patients, generally within 6 months from imatinib cessation.
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Cerrano M, Crisà E, Pregno P, Aguzzi C, Riccomagno P, Boccadoro M, Ferrero D. Excellent therapeutic results achieved in chronic myeloid leukemia patients with front-line imatinib and early treatment modifications in suboptimal responders: a retrospective study on 91 unselected patients. Am J Hematol 2013; 88:838-42. [PMID: 23757199 DOI: 10.1002/ajh.23501] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 05/27/2013] [Accepted: 05/28/2013] [Indexed: 12/15/2022]
Abstract
Second generation tyrosine kinase-inhibitors (TKI) have been claimed to represent now the first-choice therapy for chronic myeloid leukemia (CML). Indeed, they generally induce faster and deeper molecular responses compared to imatinib that, however, is equally effective in at least 50% of patients. Moreover, some recent reports have questioned the long term safety of dasatinib and nilotinib. Therefore, upfront imatinib with early shift to second generation TKI for patients with slow/incomplete response might be as effective as front-line second generation TKI, with a possibly better safety profile. We retrospectively evaluated 91 chronic phase CML patients (median follow-up 57 months, median age 61 years), treated front-line with standard-dose imatinib and early therapy modifications (at 3-12 months) in case of unsatisfactory response or intolerance. Thirty-three patients (24 with unsatisfactory response, 9 intolerant) changed therapy, either by increasing imatinib dose (11/91) or by switching to second generation TKI (22 directly, 4 after high-dose imatinib). Globally, our strategy led to complete cytogenetic response (CCyR) in 98% of the patients, major molecular response (MMR) in 88% and molecular response 4 logs (MR(4.0) ) in 62%. Three patients in CCyR (3%), 2 of them in MMR too, suddenly progressed to blastic phase. At the last follow-up nine patients had died, seven of CML-unrelated causes and two only of CML progression. These results suggest that our strategy could be as effective as front line second generation TKI, with most of patients still receiving imatinib, a drug of better known long-term side effects and lower cost.
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Affiliation(s)
- Marco Cerrano
- Hematology Division; Università degli Studi di Torino; Turin Italy
| | - Elena Crisà
- Hematology Division; Università degli Studi di Torino; Turin Italy
| | - Patrizia Pregno
- Hematology Division; Azienda Ospedaliera Città della Salute e della Scienza; Turin Italy
| | - Chiara Aguzzi
- Hematology Division; Università degli Studi di Torino; Turin Italy
| | - Paola Riccomagno
- Hematology Division; Azienda Ospedaliera Città della Salute e della Scienza; Turin Italy
| | - Mario Boccadoro
- Hematology Division; Università degli Studi di Torino; Turin Italy
| | - Dario Ferrero
- Hematology Division; Università degli Studi di Torino; Turin Italy
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Baccarani M, Deininger MW, Rosti G, Hochhaus A, Soverini S, Apperley JF, Cervantes F, Clark RE, Cortes JE, Guilhot F, Hjorth-Hansen H, Hughes TP, Kantarjian HM, Kim DW, Larson RA, Lipton JH, Mahon FX, Martinelli G, Mayer J, Müller MC, Niederwieser D, Pane F, Radich JP, Rousselot P, Saglio G, Saußele S, Schiffer C, Silver R, Simonsson B, Steegmann JL, Goldman JM, Hehlmann R. European LeukemiaNet recommendations for the management of chronic myeloid leukemia: 2013. Blood 2013; 122:872-84. [PMID: 23803709 PMCID: PMC4915804 DOI: 10.1182/blood-2013-05-501569] [Citation(s) in RCA: 1408] [Impact Index Per Article: 128.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 06/10/2013] [Indexed: 02/07/2023] Open
Abstract
Advances in chronic myeloid leukemia treatment, particularly regarding tyrosine kinase inhibitors, mandate regular updating of concepts and management. A European LeukemiaNet expert panel reviewed prior and new studies to update recommendations made in 2009. We recommend as initial treatment imatinib, nilotinib, or dasatinib. Response is assessed with standardized real quantitative polymerase chain reaction and/or cytogenetics at 3, 6, and 12 months. BCR-ABL1 transcript levels ≤10% at 3 months, <1% at 6 months, and ≤0.1% from 12 months onward define optimal response, whereas >10% at 6 months and >1% from 12 months onward define failure, mandating a change in treatment. Similarly, partial cytogenetic response (PCyR) at 3 months and complete cytogenetic response (CCyR) from 6 months onward define optimal response, whereas no CyR (Philadelphia chromosome-positive [Ph+] >95%) at 3 months, less than PCyR at 6 months, and less than CCyR from 12 months onward define failure. Between optimal and failure, there is an intermediate warning zone requiring more frequent monitoring. Similar definitions are provided for response to second-line therapy. Specific recommendations are made for patients in the accelerated and blastic phases, and for allogeneic stem cell transplantation. Optimal responders should continue therapy indefinitely, with careful surveillance, or they can be enrolled in controlled studies of treatment discontinuation once a deeper molecular response is achieved.
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Affiliation(s)
- Michele Baccarani
- Department of Hematology L. and A. Seràgnoli, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, Bologna, Italy.
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Abstract
Abstract
An 80-year-old man has newly diagnosed chronic myeloid leukemia. His BM and blood examination at diagnosis confirms chronic-phase disease, with the Philadelphia chromosome as the sole cytogenetic abnormality. He has intermediate Sokal and Hasford risk,1 and is started on imatinib 600 mg once daily. He lives 5 hours away from the nearest specialist hematology service and prefers followup with his local physician, who cannot perform BM examinations. In patients such as this, is it acceptable to monitor his therapeutic response solely with molecular studies of his peripheral blood?
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Breccia M, Alimena G. Suboptimal response in chronic myeloid leukemia patients treated with imatinib: Early identification and new therapeutic challenges. Cancer Lett 2012; 325:18-25. [DOI: 10.1016/j.canlet.2012.05.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 05/27/2012] [Accepted: 05/28/2012] [Indexed: 11/15/2022]
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37
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Current world literature. Curr Opin Oncol 2011; 23:700-9. [PMID: 21993416 DOI: 10.1097/cco.0b013e32834d384a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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38
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Breccia M, Alimena G. The current role of high-dose imatinib in chronic myeloid leukemia patients, newly diagnosed or resistant to standard dose. Expert Opin Pharmacother 2011; 12:2075-87. [DOI: 10.1517/14656566.2011.597741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Rudzki J, Wolf D. Dose escalation of imatinib in chronic-phase chronic myeloid leukemia patients: is it still reasonable? Expert Rev Hematol 2011; 4:153-9. [PMID: 21495925 DOI: 10.1586/ehm.11.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Suboptimal response or treatment failure to standard-dose imatinib are relevant problems in chronic-phase chronic myeloid leukemia patients. Insufficient adherence is one of the main causes of insufficient response but biological reasons also have to be considered. Various mechanisms of resistance have been described in the past, some of them mediating absolute resistance and others, relative resistance, to imatinib. The latter can be overcome by dose intensification of imatinib. However, the availability of second-generation tyrosine kinase inhibitors means these patients can be switched to these novel agents. Thus, which strategy is most appropriate for the individual patient with insufficient response to standard-dose imatinib remains elusive. Moreover, it remains unclear whether dose intensification of imatinib in the first-line setting might allow a more rapid and deeper response rate. This article will summarize data on imatinib dose intensification and will make recommendations about which patients imatinib dose intensification is most appropriate for.
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Affiliation(s)
- Jakob Rudzki
- Tyrolean Cancer Research Center, Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innrain 66, Innsbruck, Austria
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40
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Kantarjian H, Cortes J. Considerations in the management of patients with Philadelphia chromosome-positive chronic myeloid leukemia receiving tyrosine kinase inhibitor therapy. J Clin Oncol 2011; 29:1512-6. [PMID: 21422414 DOI: 10.1200/jco.2010.33.9176] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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41
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Hehlmann R, Lauseker M, Jung-Munkwitz S, Leitner A, Müller MC, Pletsch N, Proetel U, Haferlach C, Schlegelberger B, Balleisen L, Hänel M, Pfirrmann M, Krause SW, Nerl C, Pralle H, Gratwohl A, Hossfeld DK, Hasford J, Hochhaus A, Saussele S. Tolerability-adapted imatinib 800 mg/d versus 400 mg/d versus 400 mg/d plus interferon-α in newly diagnosed chronic myeloid leukemia. J Clin Oncol 2011; 29:1634-42. [PMID: 21422420 DOI: 10.1200/jco.2010.32.0598] [Citation(s) in RCA: 270] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
PURPOSE Treatment of chronic-phase (CP) chronic myeloid leukemia (CML) with imatinib 400 mg/d can be unsatisfactory. Optimization of treatment is warranted. PATIENTS AND METHODS In all, 1,014 newly diagnosed CP-CML patients were randomly assigned to imatinib 800 mg/d (n = 338), imatinib 400 mg/d (n = 325), or imatinib 400 mg/d plus interferon alfa (IFN-α; n = 351). Dose adaptation to avoid higher-grade toxicity was recommended. First primary end point was major molecular remission (MMR) at 12 months. RESULTS A higher rate of MMR at 12 months occurred with tolerability-adapted imatinib 800 mg/d than with imatinib 400 mg/d (59% [95% CI, 53% to 65%] v 44% [95% CI, 37% to 50%]; P < .001) or imatinib 400 mg/d plus IFN-α (59% v 46% [95% CI, 40% to 52%]; P = .002). Median dose in the 800-mg/d arm was 628 mg/d with a maximum dose of 737 mg/d during months 4 to 6 and a maintenance dose of 600 mg/d. All three treatment approaches were well tolerated with similar grade 3 and 4 adverse events. Independent of treatment approach, MMR at 12 months showed better progression-free survival (99% v 94%; P = .0023) and overall survival (99% v 93%; P = .0011) at 3 years when compared with > 1% on the international scale or no MMR but showed no difference in 0.1% to < 1% on the international scale, which closely correlates with complete cytogenetic remission. CONCLUSION Treatment of early-phase CML with imatinib can be optimized. Early high-dose therapy followed by rapid adaptation to good tolerability increases the rate of MMR at 12 months. Achievement of MMR by month 12 is directly associated with improved survival.
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Affiliation(s)
- Rüdiger Hehlmann
- Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Pettenkoferstr. 22, 68169 Mannheim, Germany.
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Identification of copy number alterations by array comparative genomic hybridization in patients with late chronic or accelerated phase chronic myeloid leukemia treated with imatinib mesylate. Int J Hematol 2011; 93:465-473. [PMID: 21387093 DOI: 10.1007/s12185-011-0796-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Revised: 02/01/2011] [Accepted: 02/13/2011] [Indexed: 10/18/2022]
Abstract
The outcome of treating chronic myeloid leukemia (CML) with imatinib mesylate (IM) is inferior when therapy is commenced in late chronic or accelerated phase as compared to early chronic phase. This may be attributed to additional genomic alterations that accumulate during disease progression. We sought to identify such lesions in patients showing suboptimal response to IM by performing array-CGH analysis on 39 sequential samples from 15 CML patients. Seventy-four cumulative copy number alterations (CNAs) consisting of 35 losses and 39 gains were identified. Alterations flanking the ABL1 and BCR genes on chromosomes 9 and 22, respectively, were the most common identified lesions with 5 patients losing variable portions of 9q34.11 proximal to ABL1. Losses involving 1p36, 5q31, 17q25, Y and gains of 3q21, 8q24, 22q11, Xp11 were among other recurrent lesions identified. Aberrations were also observed in individual patients, involving regions containing known leukemia-associated genes; CDKN2A/2B, IKZF1, RB1, TLX1, AFF4. CML patients in late stages of their disease, harbor pre-existing and evolving sub-microscopic CNAs that may influence disease progression and IM response.
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43
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Hehlmann R, Jung-Munkwitz S, Saußele S. Treatment of chronic myeloid leukemia when imatinib fails. Expert Opin Pharmacother 2011; 12:269-83. [DOI: 10.1517/14656566.2011.533169] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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44
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Correlation between genetic polymorphisms of the hOCT1 and MDR1 genes and the response to imatinib in patients newly diagnosed with chronic-phase chronic myeloid leukemia. Leuk Res 2010; 35:1014-9. [PMID: 21185600 DOI: 10.1016/j.leukres.2010.12.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 11/29/2010] [Accepted: 12/02/2010] [Indexed: 12/22/2022]
Abstract
The association between seven polymorphisms in the genes hOCT1 and MDR1, encoding for imatinib transporter proteins, and the response to imatinib 400mg/daily was investigated in 65 patients newly diagnosed with chronic-phase chronic myeloid leukemia. The AA genotype at the rs6935207 hOCT1 polymorphic locus was not detected in patients with inadequate response to imatinib. The CC genotype at the rs1045642 (C3435T) MDR1 locus was associated with primary failure, whereas a T allele at the rs2032582 (G2677T/A) MDR1 locus seemed to protect from primary failure. Beside, the MDR1 haplotype 1236T-2677G-3435C was more frequently found in patients primarily resistant to imatinib.
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45
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Tefferi A. Second-generation tyrosine kinase inhibitors in chronic myelogenous leukemia. Cancer 2010; 117:234-7. [DOI: 10.1002/cncr.25600] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 07/20/2010] [Indexed: 11/10/2022]
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