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Efficacy of Imatinib Dose Escalation in Patients With Chronic Myeloid Leukemia in Chronic Phase

Lookup NU author(s): Professor Stephen O'Brien

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Abstract

BACKGROUND: Imatinib mesylate given orally at a daily dose of 400 mg is the standard of care as initial therapy for patients with chronic myeloid leukemia (CML) in chronic phase (CML-CP). Treatment guidelines propose dose escalation based on clinical assessments of disease response. METHODS: Response and survival were analyzed in a cohort of patients (n = 106) with newly diagnosed CML-CP who were enrolled on the International Randomized Study of Interferon and STI571 (IRIS) trial, who began treatment with imatinib at a dose of 400 mg daily, and who subsequently underwent dose escalation to either 600 mg or 800 mg daily. Reasons for dose escalation were evaluated retrospectively based on 2 sets of criteria: the IRIS protocol-defined criteria (n = 39 patients) and the European LeukemiaNet (ELN) recommendations (n = 48 patients). RESULTS: Among all 106 patients who underwent dose escalation, the rates of freedom from progression to accelerated phase or blast phase and overall survival were 89% and 84% at 3 years after dose increase, respectively. A cytogenetic response was obtained in 42% of patients who had their dose escalated based on protocol criteria and in 38% of patients who had their dose escalated according to the ELN recommendations. CONCLUSIONS: The results from this retrospective analysis supported imatinib dose escalation as an appropriate initial option for patients with CML-CP who were experiencing suboptimal cytogenetic response or resistance. Cancer 2009;115:551-60. (c) 2008 American Cancer Society.

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Author(s): Kantarjian HM, Larson RA, Guilhot F, O'Brien SG, Mone M, Rudoltz M, Krahnke T, Cortes J, Druker BJ

Publication type: Article

Publication status: Published

Journal: Cancer

Year: 2009

Volume: 115

Issue: 3

Pages: 551-560

ISSN (print): 0008-543X

ISSN (electronic): 1045-7410

Publisher: John Wiley & Sons, Inc.

URL: http://dx.doi.org/10.1002/cncr.24066

DOI: 10.1002/cncr.24066

Notes: Study for the International Randomized Study of Interferon and STI571 (IRIS) Investigators

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