Survival benefit with imatinib mesylate therapy in patients with accelerated-phase chronic myelogenous leukemia - Comparison with historic experience

Hagop Kantarjian, Moshe Talpaz, Susan O'Brien, Francis Giles, Stefan Faderl, Srdan Verstovsek, Guillermo Garcia-Manero, Jianqin Shan, Mary Beth Rios, Richard Champlin, Marcos De Lima, Jorge Cortes

Research output: Contribution to journalReview article

60 Scopus citations

Abstract

BACKGROUND. The effect of imatinib mesylate on survival in the accelerated phase of chronic myelogenous leukemia (CML) is unknown. The objectives of this study were to update the long-term experience with imatinib in patients who had accelerated-phase CML and to compare outcomes with historic experience. METHODS. The outcomes of 176 patients who received treatment with imatinib were reviewed and compared with the outcomes of 213 historic control patients with accelerated-phase CML who received treatment with interferon-α or with other modalities. RESULTS. With imatinib, the complete hematologic response rate was 82% versus a rate ≤ 50% for others, and the complete cytogenetic response rate was 43% versus rates of 0-6% for others. The estimated 4-year survival rates were 53% with imatinib, 42% with interferon-α, and 0-21% for others. A multivariate analysis of the total population of 389 patients indicated that imatinib therapy (vs. other therapies) was an independent, favorable prognostic factor for survival (P < 0.0001; hazard rate, 0.62). A subset analysis that included only patients who were treated with imatinib and interferon-α (276 patients) also identified imatinib as an independent favorable prognostic factor (P < 0.0001; hazard rate, 0.65). The 3-month cytogenetic response to imatinib was associated with significantly different survival outcomes (P < 0.0001). A multivariate analysis that included pretreatment characteristics and 3-month cytogenetic response among 150 patients who received imatinib and were alive at 3 months identified only 2 adverse independent prognostic factors: lack of a cytogenetic response at 3 months (P < 0.001) and anemia (hemoglobin < 10 g/dL; P = 0.003). Patients who had neither factor (41%) had an estimated 4-year survival rate of 88%; in the other patients, the 4-year survival rate was ≤ 60%. This may have implications in relation to subsequent therapy, because, according to the outcomes of patients who underwent allogeneic transplantation in accelerated phase at the authors' institution and from literature reports, the estimates of 5-year survival were 25-30%. CONCLUSIONS. The current results suggest that imatinib improved survival compared with other therapies in patients with accelerated-phase CML.

Original languageEnglish (US)
Pages (from-to)2099-2108
Number of pages10
JournalCancer
Volume103
Issue number10
DOIs
StatePublished - May 15 2005
Externally publishedYes

Keywords

  • Accelerated phase
  • Chronic myelogenous leukemia
  • Imatinib mesylate
  • Survival

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Kantarjian, H., Talpaz, M., O'Brien, S., Giles, F., Faderl, S., Verstovsek, S., Garcia-Manero, G., Shan, J., Rios, M. B., Champlin, R., De Lima, M., & Cortes, J. (2005). Survival benefit with imatinib mesylate therapy in patients with accelerated-phase chronic myelogenous leukemia - Comparison with historic experience. Cancer, 103(10), 2099-2108. https://doi.org/10.1002/cncr.21032