OUR EXPERIENCE WITH TREATMENT OF CHRONIC MYELOID LEUKEMIA WITH IMATINIB MESYLATE
Abstract
Background. Imatinib mesylate is an Abl kinase inhibitor capable of producing a sustained complete molecular response in chronic myelogenous leukemia (CML). It is effective in all three phases of CML with the longest response in the chronic phase. Imatinib has been in use only since 1998 and many questions about its efficacy and use are still unanswered.
Methods and results. From October 2001 until January 2004 thirty-one patients with CML have been treated with imatinib (300–600 mg/day) at our institution. Twelve patients were in chronic phase of CML, 13 in accelerated phase and 3 in blast crisis. Two were treated after unrelated peripheral blood stem cell transplantation (PBSCT) due to CML reactivation. All had been treated prior to instituting imatinib (hydroxiurea, interferon – alpha, cytarabine). Complete cytogenetic response (CCR) in patients in chronic phase occured in 33.3% and complete molecular response (CMR) occured in 41.7%. CCR in patients in accelerated phase occured in 30.8% and CMR occured in 46.2%. None of the patients in blast crisis had CCR or CMR. Several side effects were reported during the treatment. However, among them there was not the most common side effect reported in other studies. Limb muscle and bone pains (20%) were the most frequently reported side effects in our group of patients.
Conclusions. Imatinib has be found to be most effective in chronic and accelerated phase of CML. However, there is still not enough data about its long-term use and prognosis. For the time being, PBSCT remains the only proven curative treatment of CML.
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References
Sawyers CL. Chronic myeloid leukemia. N Engl J Med 1999; 340:1330–40.
Goldman JM, Melo JV. Mechanisms of disease: chronic myeloid leukemia – advances in biology and new approaches to treatment. N Engl J Med 2003; 349: 1451–64.
Buchdunger E, Zimmerman J, Mett H et al. Inhibition of the Abl proteintyrosine kinase in vitro and in vivo by a 2-phenylaminopyrimidine derivative. Cancer Res 1996; 56:100–4.
Druker BJ, Tamura S, Buchdunger E et al. Effects of a selective inhibitor of the Abl tyrosine kinase on the growth of Bcr-Abl positive cells. Nat Med 1996; 2: 561–6.
Hughes TP, Branford S, Rudzki Z et al. Frequency of major molecular responses to imatinib or interferon alfa plus cytarabine in newly diagnosed chronic myeloid leukemia. N Engl J Med 2003; 349:1423–32.
Merx K, Muller MC, Kreil S et al. Early reduction of BCR-ABL transcript levelspredicts cytogenetic response in chronic phase CML patients treated with imatinib after failure of interferon alpha. Leukemia 2002; 16:1579–83.
Wang L, Pearson K, Pillitteri L, Ferguson JE, Clark RE. Serial monitoring of BCR-ABL by peripheral blood real-time polymerase chain reaction predicts the marrow cytogenetic response to imatinibe mesylate in chronic myeloid leukemia. Br J Haematol. 2002; 118: 771–7.
Kantarjian H, Sawyers C, Hochhaus A et al. Hematologic and cytogenetic responses to imatinib mesylate in chronic myelogenous leukemia. N Engl J Med 2002; 346: 645–52.
Talpaz M, Silver RT, Druker BJ et al. Imatinib induces durable hematologic and cytogenetic responses in patients with accelerated phase chronic myeloid leukemia: results of a phase 2 study. Blood 2002; 99:1928–37.
Sawyers CL, Hochaus A, Feldman E et al. Imatinib induces hematologic and cytogenetic response in patients with chronic myeloid leukemia in myeloid blast crisis: results of a phase II study. Blood 2002; 99: 3530–9.
Hochhaus A, Reiter A, Saussele S et al. Molecular heterogeneity in complete cytogenetic responders after interferon-alpha therapy for chronic myelogenous leukemia: low levels of minimal residual disease are associated with continuing remission. Blood 2000; 95: 62–6.
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