Do chronic myeloid leukemia patients with late “warning” responses benefit from “watch and wait” or switching therapy to a second generation tyrosine kinase inhibitor?
Year: 2014
Type: article
Study design: Observational Study
Abstract: 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.
Source: American Journal of Hematology
DOI: 10.1002/ajh.23816
Authors: Valentin García‐Gutiérrez, Jose Manuel Puerta, Begoña Maestro, Luis Felipe Casado Montero, Alfonso Muriel, Jose Ramon Molina Hurtado, Manuel Perez‐Encinas, Maria Victoria Moreno Romero, Pere Barba Suñol, Ricardo Sola Garcia, Raquel De Paz, Maria Jose Ramirez Sanchez, Santiago Osorio, Maria Isabel Mata Vazquez, Joaquin Martinez López, Jose Luis Sastre, Maria de los Angles Portero, Guiomar Bautista, Maria Soledad Duran Nieto, Pilar Giraldo, Margarita Jimenez Jambrina, Carmen Burgaleta, Joaquin Ruiz Aredondo, Maria Jesús Peñarrubia, Maria José Requena, María del Carmen Fernández Valle, Carmen Calle, Antonio Paz Coll, Jose Ángel Hernández‐Rivas, Rafael Franco Osorio, Pilar Cano, David Tallón Pérez, Margarita Fernández de la Mata, Pilar López Garrido, Juan Luis Steegmann
Institutions: Hospital Universitario Ramón y Cajal, Hospital Universitario Virgen de las Nieves, Hospital Virgen de la Salud, Instituto Ramón y Cajal de Investigación Sanitaria, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Hospital Universitario Reina Sofía, Hospital Juan Ramón Jiménez, Vall d'Hebron Hospital Universitari, Hospital Universitario La Paz, Hospital Universitario de Jerez, Hospital General Universitario Gregorio Marañón, Hospital Costa del Sol, Hospital Universitario 12 De Octubre, Complejo Hospitalario de Ourense, Hospital Universitario Virgen Macarena, Hospital Universitario Puerta de Hierro Majadahonda, Complejo Hospitalario de Jaén, Hospital Universitario Miguel Servet, Hospital Riotinto, Hospital Universitario Príncipe de Asturias, Hospital Clínico Universitario de Valladolid, Hospital Universitario Severo Ochoa, Hospital Universitario Puerta del Mar, Hospital General Universitario de Ciudad Real, Hospital Universitario Puerto Real, Hospital Universitario Infanta Leonor, Servicio de Salud de Castilla La Mancha, Hospital Infanta Margarita, Hospital Universitario de La Princesa
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W1580247500