scholarly journals Long-term outcomes in the second-line treatment of chronic myeloid leukemia

Cancer ◽  
2010 ◽  
Vol 117 (5) ◽  
pp. 897-906 ◽  
Author(s):  
Elias Jabbour ◽  
Jorge Cortes ◽  
Hagop Kantarjian
Keyword(s):  
Chronic Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Line Treatment ◽  
Second Line ◽  
Long Term Outcomes

scholarly journals Long-term outcomes with frontline nilotinib versus imatinib in newly diagnosed chronic myeloid leukemia in chronic phase: ENESTnd 10-year analysis

Leukemia ◽  
2021 ◽  
Author(s):  
Hagop M. Kantarjian ◽  
Timothy P. Hughes ◽  
Richard A. Larson ◽  
Dong-Wook Kim ◽  
Surapol Issaragrisil ◽  
...  
Keyword(s):  
Chronic Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Survival Rates ◽  
Chronic Phase ◽  
Individual Treatment ◽  
Molecular Response ◽  
Newly Diagnosed ◽  
Long Term Outcomes ◽  
Treatment Free Remission

AbstractIn the ENESTnd study, with ≥10 years follow-up in patients with newly diagnosed chronic myeloid leukemia (CML) in chronic phase, nilotinib demonstrated higher cumulative molecular response rates, lower rates of disease progression and CML-related death, and increased eligibility for treatment-free remission (TFR). Cumulative 10-year rates of MMR and MR4.5 were higher with nilotinib (300 mg twice daily [BID], 77.7% and 61.0%, respectively; 400 mg BID, 79.7% and 61.2%, respectively) than with imatinib (400 mg once daily [QD], 62.5% and 39.2%, respectively). Cumulative rates of TFR eligibility at 10 years were higher with nilotinib (300 mg BID, 48.6%; 400 mg BID, 47.3%) vs imatinib (29.7%). Estimated 10-year overall survival rates in nilotinib and imatinib arms were 87.6%, 90.3%, and 88.3%, respectively. Overall frequency of adverse events was similar with nilotinib and imatinib. By 10 years, higher cumulative rates of cardiovascular events were reported with nilotinib (300 mg BID, 16.5%; 400 mg BID, 23.5%) vs imatinib (3.6%), including in Framingham low-risk patients. Overall efficacy and safety results support the use of nilotinib 300 mg BID as frontline therapy for optimal long-term outcomes, especially in patients aiming for TFR. The benefit-risk profile in context of individual treatment goals should be carefully assessed.

Quality of life among chronic myeloid leukemia patients in the second-line treatment with nilotinib and influential factors

2021 ◽  
Author(s):  
Cuc Thi Thu Nguyen ◽  
Binh Thanh Nguyen ◽  
Thuy Thi Thu Nguyen ◽  
Fabio Petrelli ◽  
Stefania Scuri ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Influential Factors ◽  
Line Treatment ◽  
Second Line

scholarly journals Prognostic Significance of Transcript-Type BCR‐ABL1 in Chronic Myeloid Leukemia

2020 ◽  
Vol 12 (1) ◽  
pp. e2020062
Author(s):  
Matteo Molica ◽  
Elisabetta Abruzzese ◽  
Massimo Breccia
Keyword(s):  
Chronic Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Fusion Gene ◽  
Prognostic Significance ◽  
High Rate ◽  
Long Term Outcomes ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Molecular Responses

Chronic myeloid leukemia (CML) is characterized by the presence of the BCR-ABL1 fusion gene. In more than 95% of CML patients, the typical BCR-ABL1 transcript subtypes are e13a2 (b2a2), e14a2 (b3a2), or the simultaneous expression of both. Other less frequent transcript subtypes, such as e1a2, e2a2, e6a2, e19a2, e1a3, e13a3, and e14a3, have been sporadically reported. The main purpose of this review is to assess the possible impact of different transcripts on the response rate to tyrosine kinase inhibitors (TKIs), the achievement of stable deep molecular responses (s-DMR), the potential maintenance of treatment-free remission (TFR), and long-term outcome of CML patients treated with TKIs. According to the majority of published studies, patients with e13a2 transcript treated with imatinib have lower and slower cytogenetic and molecular responses than those with e14a2 transcript and should be considered a high-risk group who would mostly benefit from frontline treatment with second-generation TKIs (2GTIKIs). Although few studies have been published, similar significant differences in response rates to 2GTKIs have been not reported. The e14a2 transcript seems to be a favorable prognostic factor for obtaining s-DMR, irrespective of the TKI received, and is also associated with a very high rate of TFR maintenance. Indeed, patients with e13a2 transcript achieve a lower rate of s-DMR and experience a higher probability of TFR failure. According to most reported data in the literature, the type of transcript does not seem to affect long-term outcomes of CML patients treated with TKIs. In TFR, the e14a2 transcript appears to be related to favorable responses. 2GTKIs as frontline therapy might be a convenient approach in patients with e13a2 transcript to achieve optimal long-term outcomes.  

Nomogram to Prognosticate Outcomes in Patients with Chronic Myeloid Leukemia At Any Time-Point During Tyrosine Kinase Inhibitor Therapy

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 71-71
Author(s):  
Alfonso Quintás-Cardama ◽  
Xuelin Huang ◽  
Sangbum Choi ◽  
Hagop M Kantarjian ◽  
Jorge E. Cortes
Keyword(s):  
Chronic Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Phase Iii ◽  
Line Treatment ◽  
Second Line ◽  
Specific Time ◽  
Front Line ◽  
Time Points ◽  
Phase Iii Study ◽  
Time Point

Abstract Abstract 71 Background: The NCCN and the European LeukemiaNet guidelines for monitoring patients with chronic myeloid leukemia in chronic phase (CML-CP) provide recommendations for response assessment and treatment at 3, 6, 12, and 18 months based on evidence obtained in clinical trials. A clear limitation of such guidelines is their applicability at time-points different from those pre-specified. To overcome these limitations we have developed a novel statistical approach to CML prognostication. Method: In order to build our prognostic model, we used two cohorts of patients with CML-CP treated in the frontline DASISION phase III study (CA180-056) and the cohort of patients treated after imatinib failure in the dasatinib dose-optimization phase III study (CA180-034). Progression-free survival (PFS) was defined as any of the following: doubling of white cell count to >20×109/L in the absence of complete hematologic response (CHR); loss of CHR; increase in Ph+ BM metaphases to >35%; transformation to AP/BP; or death. A modified Cox proportional hazards model was used to build a prognostic nomogram. Results: A total of 1189 patients were used for this analysis: 519 from DASISION (259 dasatinib and 260 imatinib) and 670 from CA180-034. First, we devised a model to link a BCR-ABL1/ABL1 ratios (according to the International Standard) obtained at specific time points during the course of treatment with patientsÕ outcomes (PFS). For instance, at 18 months after front-line treatment, the future PFS probabilities are shown in Figure 1A. At 6 months after second-line treatment, the future PFS probabilities are shown in Figure 1B. Once the model was validated at specific time points, we next designed a nomogram to calculate patients' outcomes at any time point during the course of therapy by plotting ‘master PFS curves’ derived from the patient cohorts according to time. Figure 2A&B give the 90% quantile of the remaining PFS for patients at any time after front-line and second-line treatment, respectively. These may be used a guideline for considering other treatment options when patients' BCR-ABL1/ABL1 ratios exceed these values. Figure 2 shows that the remaining PFS times for either front- or second-line treated patients depend mostly on the current BCR-ABL/ABL ratio and less on the time at which the ratio is obtained, reflected by the fact that the curves showing future PFS probabilities are characterized by smooth slopes. Figure 2A shows that 10% of front-line treated patients whose BCR-ABL1/ABL1 ratios are 50% or higher will have remaining PFS times of less than 12 months. If BCR-ABL1/ABL1 ratios are 75% or higher, then 10% of them will have remaining PFS times of less than 6 months. Similarly, Figure 2B shows that for second-line treated patients whose BCR-ABL1/ABL1 ratios are 50% or higher, 10% of them will have remaining PFS time shorter than 6 months. Conclusion: We have designed a nomogram that predicts PFS for patients treated in the frontline and second line settings according to their BCR-ABL1/ABL1 ratios, independent from the time at which these ratios are obtained. A similar approach has been taken to predict failure-free and overall survival and will be presented at the meeting. This prognostic tool is readily available for clinical purposes and might greatly facilitate monitoring and prognostication in CML. Disclosures: No relevant conflicts of interest to declare.

Long-term treatment-free remission (TFR) in patients (pts) with chronic myeloid leukemia in chronic phase (CML-CP) after stopping second-line (2L) nilotinib: ENESTop 144-wk results.

2018 ◽  
Vol 36 (15_suppl) ◽  
pp. 7003-7003 ◽  
Author(s):  
François-Xavier Mahon ◽  
Carla Boquimpani ◽  
Naoto Takahashi ◽  
Noam Benyamini ◽  
Nelma Cristina D. Clementino ◽  
...  
Keyword(s):  
Chronic Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Chronic Phase ◽  
Term Treatment ◽  
Second Line ◽  
Long Term Treatment ◽  
Treatment Free Remission
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