title: Long-term outcome of chronic myeloid leukemia patients treated frontline with imatinib.
abstract: For almost 10 years imatinib has been the therapeutic standard of chronic myeloid leukemia. The introduction of other tyrosine kinase inhibitors (TKIs) raised a debate on treatment optimization. The debate is still heated: some studies have protocol restrictions or limited follow-up; in other studies, some relevant data are missing. The aim of this report is to provide a comprehensive, long-term, intention-to-treat, analysis of 559 newly diagnosed, chronic-phase, patients treated frontline with imatinib. With a minimum follow-up of 66 months, 65% of patients were still on imatinib, 19% were on alternative treatment, 12% died and 4% were lost to follow-up. The prognostic value of BCR-ABL1 ratio at 3 months (⩽10% in 81% of patients) was confirmed. The prognostic value of complete cytogenetic response and major molecular response at 1 year was confirmed. The 6-year overall survival was 89%, but as 50% of deaths occurred in remission, the 6-year cumulative incidence of leukemia-related death was 5%. The long-term outcome of first-line imatinib was excellent, also because of second-line treatment with other TKIs, but all responses and outcomes were inferior in high-risk patients, suggesting that to optimize treatment results, a specific risk-adapted treatment is needed for such patients.
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L and A Seràgnoli', University of Bologna, 'S Orsola-Malpighi' University Hospital, Bologna, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Castagnetti
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L and A Seràgnoli', University of Bologna, 'S Orsola-Malpighi' University Hospital, Bologna, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Gugliotta
authors.affiliation: Chair of Hematology, 'La Sapienza' University, Roma, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Breccia
authors.affiliation: Chair of Hematology, University of Catania, Catania, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Stagno
authors.affiliation: Oncohematology of the Elderly Unit, Oncohematology Division, IRCCS Ca' Granda - Maggiore University Hospital, Milano, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Iurlo
authors.affiliation: Chair of Hematology, University of Bari, Bari, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Albano
authors.affiliation: Hematology Unit, 'S Eugenio' Hospital, Roma, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Abruzzese
authors.affiliation: Hematology Unit, Azienda Ospedaliera 'Bianchi-Melacrino-Morelli', Reggio Calabria, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Martino
authors.affiliation: Hematology Unit, 'Pugliese-Ciaccio' Hospital, Catanzaro, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Levato
authors.affiliation: Hematology Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: T
authors.initials: T
authors.lastname: Intermesoli
authors.affiliation: Hematology Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Pregno
authors.affiliation: Hematology Unit, Azienda Ospedaliera 'Spedali Civili', Brescia, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Rossi
authors.affiliation: Hematology Unit, 'Ca' Foncello' Hospital, Treviso, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Gherlinzoni
authors.affiliation: Chair of Hematology, Torrette University Hospital, Ancona, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Leoni
authors.affiliation: Chair of Hematology, Azienda Ospedaliero Universitaria Arcispedale S Anna, University of Ferrara, Ferrara, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Cavazzini
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L and A Seràgnoli', University of Bologna, 'S Orsola-Malpighi' University Hospital, Bologna, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Venturi
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L and A Seràgnoli', University of Bologna, 'S Orsola-Malpighi' University Hospital, Bologna, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Soverini
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L and A Seràgnoli', University of Bologna, 'S Orsola-Malpighi' University Hospital, Bologna, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Testoni
authors.affiliation: Chair of Hematology, 'La Sapienza' University, Roma, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Alimena
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L and A Seràgnoli', University of Bologna, 'S Orsola-Malpighi' University Hospital, Bologna, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Cavo
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L and A Seràgnoli', University of Bologna, 'S Orsola-Malpighi' University Hospital, Bologna, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Martinelli
authors.affiliation: Department of Biochemistry and Medical Biotechnologies, 'Federico II' University, Napoli, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Pane
authors.affiliation: Chair of Hematology, Department of Clinical and Biological Sciences, 'S Luigi Gonzaga' University Hospital, University of Torino, Orbassano (TO), Italy.
authors.forename: G
authors.initials: G
authors.lastname: Saglio
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L and A Seràgnoli', University of Bologna, 'S Orsola-Malpighi' University Hospital, Bologna, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Rosti
authors.affiliation: Department of Hematology and Oncology 'L and A Seràgnoli', University of Bologna, Bologna, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Baccarani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D016044:Fusion Proteins, bcr-abl / Q000235:genetics; D006801:Humans; D000068877:Imatinib Mesylate / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000175:diagnosis / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D019233:Retreatment; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D000068877:Imatinib Mesylate; D016044:Fusion Proteins, bcr-abl