Do chronic myeloid leukemia patients with late 'warning' responses benefit from 'watch and wait' or switching therapy to a second generation tyrosine kinase inhibitor?
| Autor: | 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 |
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| Rok vydání: | 2014 |
| Předmět: |
Drug Substitution
Fusion Proteins bcr-abl Survival Analysis Disease-Free Survival Piperazines Pyrimidines Treatment Outcome Clinical Trials Phase III as Topic Drug Resistance Neoplasm Leukemia Myelogenous Chronic BCR-ABL Positive Benzamides Biomarkers Tumor Imatinib Mesylate Humans Multicenter Studies as Topic Watchful Waiting Protein Kinase Inhibitors Randomized Controlled Trials as Topic |
| Zdroj: | American journal of hematology. 89(11) |
| ISSN: | 1096-8652 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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