title: Treatment of Philadelphia-positive chronic myeloid leukemia with imatinib: importance of a stable molecular response.
abstract: 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.
authors.affiliation: Department of Hematology/Oncology L. and A. Seràgnoli, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Palandri
authors.forename: Ilaria
authors.initials: I
authors.lastname: Iacobucci
authors.forename: Simona
authors.initials: S
authors.lastname: Soverini
authors.forename: Fausto
authors.initials: F
authors.lastname: Castagnetti
authors.forename: Angela
authors.initials: A
authors.lastname: Poerio
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Testoni
authors.forename: Giuliana
authors.initials: G
authors.lastname: Alimena
authors.forename: Massimo
authors.initials: M
authors.lastname: Breccia
authors.forename: Giovanna
authors.initials: G
authors.lastname: Rege-Cambrin
authors.forename: Mario
authors.initials: M
authors.lastname: Tiribelli
authors.forename: Riccardo
authors.initials: R
authors.lastname: Varaldo
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Abruzzese
authors.forename: Bruno
authors.initials: B
authors.lastname: Martino
authors.forename: Luigiana
authors.initials: L
authors.lastname: Luciano
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Pane
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Saglio
authors.forename: Giovanni
authors.initials: G
authors.lastname: Martinelli
authors.forename: Michele
authors.initials: M
authors.lastname: Baccarani
authors.forename: Gianantonio
authors.initials: G
authors.lastname: Rosti
mesh_terms: 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
chemical_list: D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate; D016044:Fusion Proteins, bcr-abl