title: Follow-up of complete cytogenetic remission in patients with chronic myeloid leukemia after cessation of interferon alfa.
abstract: OBJECTIVE
  A small proportion of patients with chronic myeloid leukemia (CML) achieve a complete cytogenetic response (CCR), defined as the disappearance of Philadelphia (Ph) chromosome-positive metaphases, after treatment with interferon alfa (IFN). In this population of patients, the question of whether treatment should then be withdrawn is not yet resolved.
  
  
  METHODS
  In the present study, we followed 15 patients who stopped IFN after achieving CCR. In nine patients IFN was stopped in view of adverse reactions (n = 8) or patient's choice (n = 1). For the remaining six patients, the treatment was stopped because no BCR/ABL rearrangement could be detected by reverse transcriptase polymerase chain reaction (RT-PCR) in four successive analyses using peripheral-blood samples.
  
  
  RESULTS
  Loss of CCR and survival were not statistically different (P =.48; P =.7) for the 15 patients who stopped IFN compared with 41 other CCR patients who continued IFN therapy in our institution. The median follow-up after discontinuation of IFN treatment was 36 months (range, 6 to 108 months). Seven patients (47%) (females, or CCR > 24 months and RT-PCR negative before IFN cessation; P <.0001) did not relapse. Eight other patients (53%) relapsed (lost CCR) within 3 to 33 months of treatment discontinuation. One of them relapsed in major cytogenetic remission (MCR) and was still in MCR 87 months after stopping therapy without any treatment.
  
  
  CONCLUSIONS
  It is possible to stop IFN treatment at least in some patients with CML who achieve a prolonged period of CCR. This study also illustrates the hypothesis that persistence of low numbers of Ph-positive cells does not necessarily imply hematologic relapse.
authors.affiliation: Service des Maladies du Sang, Centre Hospitalier Universitaire de Bordeaux, Bordeaux 2, France.
authors.forename: F X
authors.initials: FX
authors.lastname: Mahon
authors.forename: X
authors.initials: X
authors.lastname: Delbrel
authors.forename: P
authors.initials: P
authors.lastname: Cony-Makhoul
authors.forename: C
authors.initials: C
authors.lastname: Fabères
authors.forename: J M
authors.initials: JM
authors.lastname: Boiron
authors.forename: C
authors.initials: C
authors.lastname: Barthe
authors.forename: C
authors.initials: C
authors.lastname: Bilhou-Nabéra
authors.forename: A
authors.initials: A
authors.lastname: Pigneux
authors.forename: G
authors.initials: G
authors.lastname: Marit
authors.forename: J
authors.initials: J
authors.lastname: Reiffers
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D016044:Fusion Proteins, bcr-abl / Q000097:blood / Q000235:genetics; D006801:Humans; D016898:Interferon-alpha / Q000008:administration & dosage* / Q000009:adverse effects; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012074:Remission Induction; D012307:Risk Factors; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents; D016898:Interferon-alpha; D016044:Fusion Proteins, bcr-abl