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| Title: | Assessment of imatinib as first-line treatment of chronic myeloid leukemia: 10-year survival results of the randomized CML study IV and impact of non-CML determinants |
| Creators Name: | Hehlmann, R. and Lauseker, M. and Saußele, S. and Pfirrmann, M. and Krause, S. and Kolb, H.J. and Neubauer, A. and Hossfeld, D.K. and Nerl, C. and Gratwohl, A. and Baerlocher, G.M. and Heim, D. and Brümmendorf, T.H. and Fabarius, A. and Haferlach, C. and Schlegelberger, B. and Müller, M.C. and Jeromin, S. and Proetel, U. and Kohlbrenner, K. and Voskanyan, A. and Rinaldetti, S. and Seifarth, W. and Spieß, B. and Balleisen, L. and Goebeler, M.C. and Hänel, M. and Ho, A. and Dengler, J. and Falge, C. and Kanz, L. and Kremers, S. and Burchert, A. and Kneba, M. and Stegelmann, F. and Köhne, C.A. and Lindemann, H.W. and Waller, C.F. and Pfreundschuh, M. and Spiekermann, K. and Berdel, W.E. and Müller, L. and Edinger, M. and Mayer, J. and Beelen, D.W. and Bentz, M. and Link, H. and Hertenstein, B. and Fuchs, R. and Wernli, M. and Schlegel, F. and Schlag, R. and de Wit, M. and Trümper, L. and Hebart, H. and Hahn, M. and Thomalla, J. and Scheid, C. and Schafhausen, P. and Verbeek, W. and Eckart, M.J. and Gassmann, W. and Pezzutto, A. and Schenk, M. and Brossart, P. and Geer, T. and Bildat, S. and Schäfer, E. and Hochhaus, A. and Hasford, J. |
| Abstract: | Chronic myeloid leukemia (CML)-study IV was designed to explore whether treatment with imatinib (IM) at 400 mg/day (n=400) could be optimized by doubling the dose (n=420), adding IFN (n=430) or cytarabine (n=158) or using IM after IFN-failure (n=128). From July 2002 to March 2012, 1551 newly diagnosed patients in chronic phase were randomized into a 5-arm study. The study was powered to detect a survival difference of 5% at 5 years. After a median observation time of 9.5 years, 10-year overall survival was 82%, 10-year progression-free survival 80% and 10-year relative survival 92%. Survival between IM400mg and any experimental arm was not different. In a multivariate analysis, risk group, major-route chromosomal aberrations, comorbidities, smoking and treatment center (academic vs. other) influenced survival significantly, but not any form of treatment optimization. Patients reaching the molecular response milestones at 3, 6, and 12 months had a significant survival advantage. For responders, monotherapy with IM400 mg provides a close to normal life expectancy independent of the time to response. Survival is more determined by patients' and disease factors than by initial treatment selection. Although improvements are also needed for refractory disease, more life-time can currently be gained by carefully addressing non-CML determinants of survival. |
| Keywords: | Antineoplastic Agents, Dose-Response Relationship, Drug, Hematopoietic Stem Cell Transplantation, Imatinib Mesylate, Leukemia, Myelogenous, Chronic, BCR-ABL Positive, Survival Analysis, Young Adult |
| Source: | Leukemia |
| ISSN: | 0887-6924 |
| Publisher: | Nature Publishing Group |
| Volume: | 31 |
| Number: | 11 |
| Page Range: | 2398-2406 |
| Date: | November 2017 |
| Official Publication: | https://doi.org/10.1038/leu.2017.253 |
| External Fulltext: | View full text on PubMed Central |
| PubMed: | View item in PubMed |
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