title: Tyrosine kinase inhibitors as initial therapy for patients with chronic myeloid leukemia in accelerated phase.
abstract: BACKGROUND
  Accelerated phase CML most frequently represents a progression state in CML. However, some patients present with AP features at the time of diagnosis. There is limited information on the outcome of these patients who received TKIs as initial therapy.
  
  
  METHODS
  We analyzed the outcome of 51 consecutive patients with CML who presented with features of AP at the time of diagnosis, including blasts ≥ 15% (n = 6), basophils ≥ 20% (n = 22), platelets < 100 × 10(9)/L (n = 3), cytogenetic clonal evolution (n = 17), or more than 1 feature (n = 3). Patients received initial therapy with imatinib (n = 30), dasatinib (n = 5), or nilotinib (n = 16).
  
  
  RESULTS
  The rate of complete cytogenetic response for patients treated with imatinib was 80%, and with dasatinib or nilotinib was 90%. Major molecular response (MMR) (Breakpoint Cluster Region (BCR)-Abelson (ABL)/ABL ≤ 0.1%, International Scale [IS]) was achieved in 69% of patients including complete molecular response (BCR-ABL/ABL ≤ 0.0032% IS) in 49%. MMR rates for patients treated with imatinib were 63%, and with 2GTKIs, 76%. Overall survival at 36 months was 87% with imatinib and 95% with 2GTKIs.
  
  
  CONCLUSIONS
  TKIs should be considered standard initial therapy for patients with AP at the time of diagnosis.
authors: Department of Leukemia, M.D. Anderson Cancer Center, Houston, TX.
authors: Maro
authors: M
authors: Ohanian
authors: Department of Leukemia, M.D. Anderson Cancer Center, Houston, TX.
authors: Hagop M
authors: HM
authors: Kantarjian
authors: Department of Leukemia, M.D. Anderson Cancer Center, Houston, TX.
authors: Alfonso
authors: A
authors: Quintas-Cardama
authors: Department of Leukemia, M.D. Anderson Cancer Center, Houston, TX.
authors: Elias
authors: E
authors: Jabbour
authors: Department of Leukemia, M.D. Anderson Cancer Center, Houston, TX.
authors: Lynne
authors: L
authors: Abruzzo
authors: Department of Leukemia, M.D. Anderson Cancer Center, Houston, TX.
authors: Srdan
authors: S
authors: Verstovsek
authors: Department of Leukemia, M.D. Anderson Cancer Center, Houston, TX.
authors: Gautam
authors: G
authors: Borthakur
authors: Department of Leukemia, M.D. Anderson Cancer Center, Houston, TX.
authors: Farhad
authors: F
authors: Ravandi
authors: Department of Leukemia, M.D. Anderson Cancer Center, Houston, TX.
authors: Guillermo
authors: G
authors: Garcia-Manero
authors: Department of Leukemia, M.D. Anderson Cancer Center, Houston, TX.
authors: Richard
authors: R
authors: Champlin
authors: Department of Leukemia, M.D. Anderson Cancer Center, Houston, TX.
authors: Sherry
authors: S
authors: Pierce
authors: Department of Leukemia, M.D. Anderson Cancer Center, Houston, TX.
authors: Mona Lisa
authors: ML
authors: Alattar
authors: Department of Leukemia, M.D. Anderson Cancer Center, Houston, TX.
authors: Long Xuan
authors: LX
authors: Trinh
authors: Department of Leukemia, M.D. Anderson Cancer Center, Houston, TX.
authors: Raja
authors: R
authors: Luthra
authors: Department of Leukemia, M.D. Anderson Cancer Center, Houston, TX.
authors: Alessandra
authors: A
authors: Ferrajoli
authors: Department of Leukemia, M.D. Anderson Cancer Center, Houston, TX.
authors: Tapan
authors: T
authors: Kadia
authors: Department of Leukemia, M.D. Anderson Cancer Center, Houston, TX.
authors: Susan
authors: S
authors: O'Brien
authors: Department of Leukemia, M.D. Anderson Cancer Center, Houston, TX. Electronic address: jcortes@mdanderson.org.
authors: Jorge E
authors: JE
authors: Cortes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001549:Benzamides / Q000627:therapeutic use; D000069439:Dasatinib; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D016044:Fusion Proteins, bcr-abl / Q000037:antagonists & inhibitors / Q000235:genetics; D006801:Humans; D000068877:Imatinib Mesylate; D015465:Leukemia, Myeloid, Accelerated Phase / Q000175:diagnosis* / Q000188:drug therapy* / Q000235:genetics; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000627:therapeutic use; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors*; D011743:Pyrimidines / Q000627:therapeutic use; D013844:Thiazoles / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001549:Benzamides; D010879:Piperazines; D047428:Protein Kinase Inhibitors; D011743:Pyrimidines; D013844:Thiazoles; D000068877:Imatinib Mesylate; D011505:Protein-Tyrosine Kinases; D016044:Fusion Proteins, bcr-abl; C498826:nilotinib; D000069439:Dasatinib
keywords: Accelerated phase CML (CML-AP); Complete cytogenetic response (CCyR); Major molecular response (MMR); Second generation TKI (2GTKIs); Tyrosine kinase inhibitors (TKI)