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Imatinib for CML as frontline therapy- Zagreb Experience

Background: Imatinib is frontline therapy for chronic phase Philadelphia positive chronic myeloid leukemia (Ph+ CML). In about 70% of patients optimal treatment response could be achieved and sustained for more than 7 years of therapy. We present the experience of the imatinib frontline treatment for CML in University Hospital Center Zagreb, Department of Hematology. Patients and methods: A total of sixty seven patients with Ph+ CML were treated with first line imatinib, from February 2003. Here we evaluated fifty eight of them, who were eligible for twelve months follow up. Median follow up time was fifty two months (range 12-103 months). There were males and females, with a median age of forty nine years (range 14-74, years). Patients were treated with 400 mg/day. They were regularly checked for treatment response every 3 months with cytogenetic methods (G-banding and FISH) and quantitative RT-PCR. Results: In forty one patients (70%) complete cytogenetic response (CCR) was documented. Out of those forty one patients, twelve patients (20%) achieved complete molecular response (CMR). Twenty three patients (40%) achieved a major molecular response (MMR). Two patients (3.4%) were resistant to first line treatment and were subsequently treated with nilotinib. Another two patients (3.4%) progressed to acute lymphoblastic leukemia, both after 2.5 months of the therapy with imatinib. One of them had a T315I mutation, and was subsequently treated with MUD allogeneic stem cell transplantation. One patient progressed to acute myeloid leukemia. Another patient had a progression of the disease during the chronic phase, with a verified T315I mutation. He was treated with allogeneic stem cell transplantation. Eight patients (13%) died during the course of the treatment of the disease. In four patients imatinib dose was increased to 600 mg or 800 mg. Subsequent optimal response was documented in all four patients. Two patients (3%) had serious side effects to the treatment and were therefore switched to nilotinib. Conclusion: Optimal response with imatinib is reported in 41 patients. Progression of the disease to accelerated/blastic phase was found in 3 patients. Eight patients died. Four because of CML. Our experience has proved also that imatinib is an effective frontline therapy for Ph+CML.

imatinib, CML, frontline therapy

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