Treatment of Philadelphia-positive chronic myeloid leukemia with imatinib: importance of a stable molecular response.
OBJECTIVE
The achievement of a major molecular response (MMolR) at 12 months is a surrogate marker of progression-free survival in chronic myeloid leukemia patients treated with imatinib.


METHODS
We evaluated the prognostic value of the long-term evolution of the molecular response based on a retrospective analysis of 130 late chronic phase chronic myeloid leukemia patients who achieved a complete cytogenetic response (CCgR) with 400 mg/d imatinib and have now a median follow-up of 72 months (range, 48-77).


RESULTS
In 71 (55%) patients, molecular response was consistently major (stable MMolR); in 19 (15%) patients, molecular response was occasionally less than major (unstable MMolR); in 40 (30%) patients, MMolR was never achieved (never MMolR) during all the course of CCgR. Patients with stable MMolR had a longer CCgR duration and a significantly better progression-free survival compared with patients with absent or unstable MMolR. The achievement of a MMolR, if maintained continuously, conferred a marked long-term stability to the CCgR: patients with a stable MMolR have a significantly lower risk of losing the CCgR than patients with unstable and never MMolR (4% versus 21%, P = 0.03, and 4% versus 33%, P < 0.0001, respectively). Finally, if a MMolR is not maintained consistently, the risk of losing the CCgR is higher but not significantly than if it is never achieved (33% versus 21%, P = 0.5).


CONCLUSIONS
These data confirm that achieving a MMolR is prognostically important but point out that the prognostic value of achieving a MMolR is greater if the response is confirmed and stable.
Palandri
Francesca
F
Department of Hematology/Oncology L. and A. Seràgnoli, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Iacobucci
Ilaria
I
Soverini
Simona
S
Castagnetti
Fausto
F
Poerio
Angela
A
Testoni
Nicoletta
N
Alimena
Giuliana
G
Breccia
Massimo
M
Rege-Cambrin
Giovanna
G
Tiribelli
Mario
M
Varaldo
Riccardo
R
Abruzzese
Elisabetta
E
Martino
Bruno
B
Luciano
Luigiana
L
Pane
Fabrizio
F
Saglio
Giuseppe
G
Martinelli
Giovanni
G
Baccarani
Michele
M
Rosti
Gianantonio
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001549:Benzamides; D018572:Disease-Free Survival; D005260:Female; D016044:Fusion Proteins, bcr-abl / Q000032:analysis*; D006801:Humans; D000068877:Imatinib Mesylate; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy / Q000235:genetics*; D015466:Leukemia, Myeloid, Chronic-Phase / Q000188:drug therapy / Q000235:genetics*; D008297:Male; D008875:Middle Aged; D010879:Piperazines; D011379:Prognosis; D011743:Pyrimidines; D013997:Time Factors
D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate; D016044:Fusion Proteins, bcr-abl