Deep Molecular Response Is Reached by the Majority of Patients Treated With Imatinib, Predicts Survival, and Is Achieved More Quickly by Optimized High-Dose Imatinib: Results From the Randomized CML-Study IV
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Published:2014-02-10
Issue:5
Volume:32
Page:415-423
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ISSN:0732-183X
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Container-title:Journal of Clinical Oncology
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language:en
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Short-container-title:JCO
Author:
Hehlmann Rüdiger1, Müller Martin C.1, Lauseker Michael1, Hanfstein Benjamin1, Fabarius Alice1, Schreiber Annette1, Proetel Ulrike1, Pletsch Nadine1, Pfirrmann Markus1, Haferlach Claudia1, Schnittger Susanne1, Einsele Hermann1, Dengler Jolanta1, Falge Christiane1, Kanz Lothar1, Neubauer Andreas1, Kneba Michael1, Stegelmann Frank1, Pfreundschuh Michael1, Waller Cornelius F.1, Spiekermann Karsten1, Baerlocher Gabriela M.1, Ehninger Gerhard1, Heim Dominik1, Heimpel Hermann1, Nerl Christoph1, Krause Stefan W.1, Hossfeld Dieter K.1, Kolb Hans-Jochem1, Hasford Joerg1, Saußele Susanne1, Hochhaus Andreas1
Affiliation:
1. Rüdiger Hehlmann, Martin C. Müller, Benjamin Hanfstein, Alice Fabarius, Annette Schreiber, Ulrike Proetel, Nadine Pletsch, Susanne Saußele, Universitätsmedizin Mannheim Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim; Jolanta Dengler Universitätsklinikum Heidelberg, Heidelberg; Michael Lauseker, Markus Pfirrmann, Joerg Hasford, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität; Christoph Nerl, Städtisches Klinikum...
Abstract
Purpose Deep molecular response (MR4.5) defines a subgroup of patients with chronic myeloid leukemia (CML) who may stay in unmaintained remission after treatment discontinuation. It is unclear how many patients achieve MR4.5 under different treatment modalities and whether MR4.5 predicts survival. Patients and Methods Patients from the randomized CML-Study IV were analyzed for confirmed MR4.5 which was defined as ≥ 4.5 log reduction of BCR-ABL on the international scale (IS) and determined by reverse transcriptase polymerase chain reaction in two consecutive analyses. Landmark analyses were performed to assess the impact of MR4.5 on survival. Results Of 1,551 randomly assigned patients, 1,524 were assessable. After a median observation time of 67.5 months, 5-year overall survival (OS) was 90%, 5-year progression-free-survival was 87.5%, and 8-year OS was 86%. The cumulative incidence of MR4.5 after 9 years was 70% (median, 4.9 years); confirmed MR4.5 was 54%. MR4.5 was reached more quickly with optimized high-dose imatinib than with imatinib 400 mg/day (P = .016). Independent of treatment approach, confirmed MR4.5 at 4 years predicted significantly higher survival probabilities than 0.1% to 1% IS, which corresponds to complete cytogenetic remission (8-year OS, 92% v 83%; P = .047). High-dose imatinib and early major molecular remission predicted MR4.5. No patient with confirmed MR4.5 has experienced progression. Conclusion MR4.5 is a new molecular predictor of long-term outcome, is reached by a majority of patients treated with imatinib, and is achieved more quickly with optimized high-dose imatinib, which may provide an improved therapeutic basis for treatment discontinuation in CML.
Publisher
American Society of Clinical Oncology (ASCO)
Subject
Cancer Research,Oncology
Cited by
258 articles.
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