Long-term outcome of chronic myeloid leukemia patients treated frontline with imatinib

Castagnetti, F; Gugliotta, G.; Breccia, M.; Stagno, F.; Iurlo, A.; Albano, F.; Abruzzese, E.; Martino, B.; Levato, L.; Intermesoli, T.; Pregno, P.; Rossi, G.; Gherlinzoni, F.; Leoni, P.; Cavazzini, F.; Venturi, C.; Soverini, S.; Testoni, N.; Alimena, G.; Cavo, M.; Martinelli, G.; Pane, F.; Saglio, G.; Rosti, G.; Baccarani, M.; on behalf of the GIMEMA CML Working Party (Lucarelli, G.; Polimeno, G.; Ladetto, M.; Pini, M.; Rupoli, S.; Scortechini, A. R.; Galieni, P.; Bigazzi, C.; Cantore, N.; Palmieri, F.; Specchia, G.; Russo, Rossi.; Rambaldi, A.; Ferrari, M. L.; Palandri, F.; Luatti, S.; Iacobucci, I.; Bochicchio, M. T.; Apolinari, M.; Fogli, M.; Cervello, I.; Capucci, A.; Giuliani, G.; Malpignano, A.; Girasoli, M.; Angelucci, E.; Usala, E.; De Biasi, E.; Tagariello, G.; Sartori, R.; Di Raimondo, F.; Vigneri, P.; Molica, S.; Lentini, M.; Lanza, F.; Viganò, C.; Grasso, M.; Rapezzi, D.; Cuneo, A.; Ciccone, M.; Bosi, A.; Gozzini, A.; Gobbi, M.; Pierri, I.; Chianese, R.; De Blasio, A.; Ciccone, F.; Capochiani, E.; Pelosini, M.; Musolino, C.; Russo, S.; Cortelezzi, A.; Luppi, M.; Marasca, R.; Pogliani, E. M.; Gambacorti-Passerini, C.; Luciano, L.; Izzo, B.; Ferrara, F.; Annunziata, M.; Mettivier, V.; Sessa, U.; Latte, G.; Noli, D.; Rege-Cambrin, G.; Fava, C.; Semenzato, G.; Binotto, G.; Fabbiano, F.; Turri, D.; Siragusa, S.; Caracciolo, C.; Musso, M.; Porretto, F.; Cazzola, M.; Orlandi, E.; Falini, B.; Falzetti, F.; Visani, G.; Isidor, I.; Di Bartolomeo, P.; Di Lorenzo, R.; Vallisa, D.; Trabacch, I.; Pizzuti, M.; Zuffa, E.; Salvucci, M.; Ronco, F.; Lelo, D.; Merli, F.; Avanzini, P.; Tosi, P.; Merli, A.; Sica, S.; Sorà, F.; Latagliata, R.; De Fabritiis, P.; Trawiska, M.; Amadori, S.; Cantonetti, M.; Majolino, I.; Pacilli, L.; Ronci, B.; Cedrone, M.; Mengarelli, A.; Romano, A.; Tafuri, A.; Montefusc, O.; Iuliano, F.; Infusino, S.; Dore, F.; Fozza, C.; Bocchia, M.; Defina, M.; Liberati, Am.; Luzi, D.; Boccadoro, M.; Ferrero, D.; Vitolo, U.; Nicolosi, M.; Gottardi, M.; Calistri, E.; Fanin, R.; Tiribelli, M.; Pizzolo, G.; Bonifacio, M.; Rodeghiero, F.; Di Bona, E. ).

doi:10.1038/leu.2015.152

For almost 10 years imatinib has been the therapeutic standard of chronic myeloid leukemia. The introduction of other tyrosine kinase inhibitors (TKIs) raised a debate on treatment optimization. The debate is still heated: some studies have protocol restrictions or limited follow-up; in other studies, some relevant data are missing. The aim of this report is to provide a comprehensive, long-term, intention-to-treat, analysis of 559 newly diagnosed, chronic-phase, patients treated frontline with imatinib. With a minimum follow-up of 66 months, 65% of patients were still on imatinib, 19% were on alternative treatment, 12% died and 4% were lost to follow-up. The prognostic value of BCR-ABL1 ratio at 3 months (≤10% in 81% of patients) was confirmed. The prognostic value of complete cytogenetic response and major molecular response at 1 year was confirmed. The 6-year overall survival was 89%, but as 50% of deaths occurred in remission, the 6-year cumulative incidence of leukemia-related death was 5%. The long-term outcome of first-line imatinib was excellent, also because of second-line treatment with other TKIs, but all responses and outcomes were inferior in high-risk patients, suggesting that to optimize treatment results, a specific risk-adapted treatment is needed for such patients.