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HANFSTEIN, B; MÜLLER, M. C; KOLB, H.-J; KRAUSE, S. W; HOFMANN, W.-K; SCHUBERT, J; EINSELE, H; DENGLER, J; HÄNEL, M; FALGE, C; KANZ, L; NEUBAUER, A; HEHLMANN, R; KNEBA, M; STEGELMANN, F; PFREUNDSCHUH, M; WALLER, C. F; BRANFORD, S; HUGHES, T. P; SPIEKERMANN, K; BAERLOCHER, G. M; PFIRRMANN, M; HASFORD, J; ERBEN, P; SAUSSELE, S; HOCHHAUS, A; LAUSEKER, M; FABARIUS, A; SCHNITTGER, S; HAFERLACH, C; GÖHRING, G; PROETEL, U
Leukemia, 09/2012, Volume: 26, Issue: 9Journal Article
In the face of competing first-line treatment options for CML, early prediction of prognosis on imatinib is desirable to assure favorable survival or otherwise consider the use of a second-generation tyrosine kinase inhibitor (TKI). A total of 1303 newly diagnosed imatinib-treated patients (pts) were investigated to correlate molecular and cytogenetic response at 3 and 6 months with progression-free and overall survival (PFS, OS). The persistence of BCR-ABL transcript levels >10% according to the international scale (BCR-ABL(IS)) at 3 months separated a high-risk group (28% of pts; 5-year OS: 87%) from a group with >1-10% BCR-ABL(IS) (41% of pts; 5-year OS: 94%; P=0.012) and from a group with ≤1% BCR-ABL(IS) (31% of pts; 5-year OS: 97%; P=0.004). Cytogenetics identified high-risk pts by >35% Philadelphia chromosome-positive metaphases (Ph+, 27% of pts; 5-year OS: 87%) compared with ≤35% Ph+ (73% of pts; 5-year OS: 95%; P=0.036). At 6 months, >1% BCR-ABL(IS) (37% of pts; 5-year OS: 89%) was associated with inferior survival compared with ≤1% (63% of pts; 5-year OS: 97%; P<0.001) and correspondingly >0% Ph+ (34% of pts; 5-year OS: 91%) compared with 0% Ph+ (66% of pts; 5-year OS: 97%; P=0.015). Treatment optimization is recommended for pts missing these landmarks.
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