title: Imatinib dose reduction in patients with chronic myeloid leukemia in sustained deep molecular response.
abstract: To determine whether a lower imatinib dose could minimize toxicity while maintaining the molecular response (MR), imatinib dose was reduced to 300 mg daily in 43 patients with chronic myeloid leukemia (CML) in sustained deep molecular response to first-line imatinib 400 mg daily. At the time of dose reduction, median duration of the deep response was 4.1 (interquartile range (IQR) 2.2-5.9) years; molecular response was MR4, MR4.5, and MR5of the international scale in 6, 28, and 9 patients, respectively. Toxicity grade was 1, 2, and 3 in 28, 8, and 1 patients, respectively; 6 patients underwent dose reduction without having side effects. With a median of 1.6 (IQR 0.7-3.2) years on imatinib 300 mg daily, only one patient lost the deep molecular response to MR3. At the last follow-up, response was MR3, MR4, MR4.5, and MR5in 1, 3, 9, and 30 patients, respectively. Toxicity improvement was observed in 23 (62.2 %) of the 37 patients with side effects, decreasing to grade 0 in 20 of them. All but one anemic patients improved (p = 0.01), the median Hb increase in this subgroup of patients being 1 g/dL. In CML patients with sustained deep response to the standard imatinib dose, reducing to 300 mg daily significantly improves tolerability and preserves efficacy.
authors.affiliation: Hematology Department, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain. fcervan@clinic.ub.es.
authors.forename: Francisco
authors.initials: F
authors.lastname: Cervantes
authors.affiliation: Hematology Department, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
authors.forename: Juan-Gonzalo
authors.initials: JG
authors.lastname: Correa
authors.affiliation: Hospital Gregorio Marañón, Madrid, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Pérez
authors.affiliation: Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: Valentín
authors.initials: V
authors.lastname: García-Gutiérrez
authors.affiliation: Hospital Gregorio Marañón, Madrid, Spain.
authors.forename: Sara
authors.initials: S
authors.lastname: Redondo
authors.affiliation: Hematopathology Unit, Hospital Clínic, IDIBAPS, Barcelona, Spain.
authors.forename: Dolors
authors.initials: D
authors.lastname: Colomer
authors.affiliation: IBIMA, Hospital Regional Universitario de Málaga, Málaga, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Jiménez-Velasco
authors.affiliation: Hospital de la Princesa, Madrid, Spain.
authors.forename: Juan-Luis
authors.initials: JL
authors.lastname: Steegmann
authors.affiliation: IBSAL-Hospital Clínico Universitario, Salamanca, Spain.
authors.forename: Fermín
authors.initials: F
authors.lastname: Sánchez-Guijo
authors.affiliation: Hospital Universitario Morales-Meseguer, IMIB, UCAM, Murcia, Spain.
authors.forename: Francisca
authors.initials: F
authors.lastname: Ferrer-Marín
authors.affiliation: Hematology Department, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
authors.forename: Arturo
authors.initials: A
authors.lastname: Pereira
authors.affiliation: Hospital Gregorio Marañón, Madrid, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Osorio
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D000068877:Imatinib Mesylate / Q000008:administration & dosage*; D015466:Leukemia, Myeloid, Chronic-Phase / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D000068877:Imatinib Mesylate
keywords: Chronic myeloid leukemia; Deep molecular response; Dose reduction; Imatinib; Toxicity