Prognostic factors associated with a stable MR4.5 achievement in chronic myeloid leukemia patients treated with imatinib
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Massimo Breccia1, Matteo Molica1, Gioia Colafigli1, Fulvio Massaro1, Luisa Quattrocchi1, Roberto Latagliata1, Marco Mancini1, Daniela Diverio1, Anna Guarini1, Giuliana Alimena1 and Robin Foà1
1Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
Massimo Breccia, email: [email protected]
Keywords: chronic myeloid leukemia; deep molecular response; imatinib; prognosis; discontinuation
Received: June 04, 2017 Accepted: November 05, 2017 Published: December 26, 2017
Deep molecular response in chronic myeloid leukemia (CML) patients treated with imatinib is a prerequisite for possible discontinuation. We identify clinico-biologic features linked with the probability of reaching MR4.5 (BCR-ABL/ABL ≤ 0.0032% IS) as a stable response (confirmed on two or more consecutive determinations). In a series of 208 patients treated with imatinib first-line outside clinical trials, after a median follow-up of 7 years the incidence of stable MR4.5 was 34.6%, obtained in median time of 5.4 years. In univariate analysis, female gender (p = 0.02), lower median age (56.4 vs 58.6, p = 0.03), Sokal risk stratification (p = 0.01) and e14a2 type of transcript (43% vs 31%, p = 0.02) are associated to achievement of a stable MR4.5. In multivariate regression analysis, female gender (HR 1.6, 95% CI: 1.1–2.6; P = 0.022), Sokal risk (HR 1.4, 95% CI: 1.1–2.3; p = 0.03), type of transcript (e14a2 vs e13a2 type, HR 1.6, 95% CI: 1.3–2.9; P = 0.03) and achievement of an early molecular response (EMR) at 3 months (HR 1.5, 95% CI: 1.2–2.8; P = 0.01), retained statistical significance. These clinical and biologic features associated with the achievement of a stable deep molecular response should be taken into account at a time when treatment-free remission strategies are being actively pursued in the management of CML.
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