Premium
Do chronic myeloid leukemia patients with late “warning” responses benefit from “watch and wait” or switching therapy to a second generation tyrosine kinase inhibitor?
Author(s) -
GarcíaGutiérrez Valentin,
Puerta Jose Manuel,
Maestro Begoña,
Casado Montero Luis Felipe,
Muriel Alfonso,
Molina Hurtado Jose Ramon,
PerezEncinas Manuel,
Moreno Romero Maria Victoria,
Suñol Pere Barba,
Sola Garcia Ricardo,
De Paz Raquel,
Ramirez Sanchez Maria Jose,
Osorio Santiago,
Mata Vazquez Maria Isabel,
Martinez López Joaquin,
Sastre Jose Luis,
Portero Maria de los Angles,
Bautista Guiomar,
Duran Nieto Maria Soledad,
Giraldo Pilar,
Jimenez Jambrina Margarita,
Burgaleta Carmen,
Ruiz Aredondo Joaquin,
Peñarrubia Maria Jesús,
Requena Maria José,
Fernández Valle María del Carmen,
Calle Carmen,
Paz Coll Antonio,
HernándezRivas Jose Ángel,
Franco Osorio Rafael,
Cano Pilar,
Tallón Pérez David,
Fernández de la Mata Margarita,
Garrido Pilar López,
Steegmann Juan Luis
Publication year - 2014
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.23816
Subject(s) - discontinuation , medicine , imatinib , tyrosine kinase inhibitor , myeloid leukemia , oncology , tyrosine kinase , dasatinib , cancer , receptor
In the latest recommendations for the management of chronic‐phase chronic myeloid leukemia suboptimal responses have been reclassified as “warning responses.” In contrast to previous recommendations current guidance advises close monitoring without changing therapy. We have identified 198 patients treated with first‐line imatinib, with a warning response after 12 months of treatment (patients with a complete cytogenetic response but no major molecular response [MMR]). One hundred and forty‐six patients remained on imatinib, while 52 patients changed treatment to a second generation tyrosine kinase inhibitor (2GTKI). Changing therapy did not correlate with an increase in overall survival or progression‐free survival. Nevertheless, a significant improvement was observed in the probability of a MMR: 24% vs. 42% by 12 months and 43% vs. 64% by 24 months ( P = 0.002); as well as the probability of achieving a deep molecular responses (MR 4.5 ): 1% vs. 17% and 7% vs. 23% by 12 and 24 months, respectively ( P = <0.001) .The treatment change to 2GTKI remained safe; however, we have observed a 19% of treatment discontinuation due to side effects. We have observed an improvement of molecular responses after changing treatment to 2GTKI in patients with late suboptimal response treated with imatinib first line. However, these benefits were not correlated with an improvement of progression free survival or overall survival. Am. J. Hematol. 89:E206–E211, 2014. © 2014 Wiley Periodicals, Inc.