Premium
The clinical impact of time to response in de novo accelerated‐phase chronic myeloid leukemia
Author(s) -
Ohanian Maro,
Kantarjian Hagop M.,
Shoukier Mahran,
Dellasala Sara,
Musaelyan Arine,
Nogueras Gonzalez Graciela M.,
Jabbour Elias,
Abruzzo Lynne,
Verstovsek Srdan,
Borthakur Gautam,
Ravandi Farhad,
GarciaManero Guillermo,
Tamamyan Gevorg,
Champlin Richard,
Pierce Sherry,
Ferrajoli Alessandra,
Kadia Tapan,
Cortes Jorge E.
Publication year - 2020
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.25907
Subject(s) - nilotinib , dasatinib , medicine , imatinib , myeloid leukemia , gastroenterology , imatinib mesylate , tyrosine kinase inhibitor , oncology , immunology , cancer
We aimed to describe the impact of time to response on the outcomes of 75 patients with accelerated‐phase chronic myeloid leukemia (CML‐AP) at diagnosis. Patients had at least 1 feature of AP: blasts ≥15% (n = 2), basophils ≥20% (n = 19), platelets <100 × 10 9 /L (n = 7), cytogenetic clonal evolution (n = 34), or more than one factor (n = 13). Thirty‐three patients received imatinib; 42 received a second‐generation tyrosine kinase inhibitor (2GTKI) (19 dasatinib and 23 nilotinib). We used chi‐square and Kaplan‐Meier analyses to determine the impact of various degrees of molecular and cytogenetic response at early time points (3 and 6 months) on rates of overall cytogenetic and molecular response, overall survival (OS), event‐free survival (EFS), transformation‐free survival (TFS), and failure‐free survival (FFS). After a median follow‐up of 96 months (range: 18‐224 months), the overall rate of complete cytogenetic response was 79%, of major molecular response, 71%, and of molecular reponse (MR)4.5, 59%. Patients who achieved a major cytogenetic response (MCyR) (n = 49) at 3 months had significantly better 3‐year OS (94% vs 75%; P = .002), TFS (98% vs 73%; P < .001), EFS (93% vs 42%; P < .001), and FFS (83% vs 25%; P < .001) rates than patients who did not have MCyR at 3 months. Most (67%) who eventually achieved sustained MR4.5 had achieved MCyR at 3 months. In de novo CML‐AP, early response at 3 and 6 months is a strong determinant of long‐term outcome.