Medline ® Abstract for Reference 54
of 'Treatment of chronic myeloid leukemia in chronic phase after failure of initial therapy'
Imatinib mesylate dose escalation is associated with durable responses in patients with chronic myeloid leukemia after cytogenetic failure on standard-dose imatinib therapy.
Jabbour E, Kantarjian HM, Jones D, Shan J, O'Brien S, Reddy N, Wierda WG, Faderl S, Garcia-Manero G, Verstovsek S, Rios MB, Cortes J
Blood. 2009;113(10):2154. Epub 2008 Dec 5.
We assessed the long-term efficacy of imatinib dose escalation in 84 patients with chronic myeloid leukemia in chronic phase who met the criteria of failure to standard-dose imatinib. Twenty-one patients with hematologic failure and 63 with cytogenetic failure had their imatinib dose escalated from 400 to 800 mg daily (n = 72) or from 300 to 600 mg daily (n = 12). After a median follow-up of 61 months from dose escalation, 69% remained alive. Complete cytogenetic responses were achieved in 40%; including 52% of patients with cytogenetic failure and 5% of those with hematologic failure. The estimated 2- and 3-year event-free survival and overall survival rates were 57% and 47%, and 84% and 76%, respectively. Responses were long-lasting; 88% of patients with major cytogenetic response sustained their response beyond 2 years. Treatment was well tolerated, with 76% of patients, at 12 months, continuing to receive imatinib at 100% of the intended dose. In conclusion, imatinib dose escalation can induce sustained responses in a subset of patients with cytogenetic failure and a previous cytogenetic response to standard-dose imatinib.
Department of Leukemia, University of Texas M D Anderson Cancer Center, Houston, TX 77030, USA.