Contributions
Abstract: PB1836
Type: Publication Only
Background
In large trials, patients with chronic myeloid leukaemia (CML) treated with Tyrosine Kinase Inhibitors (TKIs) have relative survival rates of up to 90% that of age-matched controls. Patients achieving complete cytogenetic responses (CCyR) within 2 years of starting Imatinib have survival rates equivalent to the general population. Newer TKIs are associated with faster and deeper treatment responses, but have a more toxic side effect profile as well as being more costly.
Aims
This study looks at the 11 year experience of a single teaching hospital treating a population of almost one million and presents the response and survival data of this unselected population of patients with CML treated with imatinib as initial therapy.
Methods
A retrospective case record review was undertaken on CML patients identified from the regional cytogenetics department. Imatinib was available for routine prescription in the UK from 2003, so a 11-year period from 2003 to 2013 was selected to allow for adequate follow-up.
Results
In total 83 patients were newly diagnosed in this time period. Four patients, treated on SPIRIT2 with dasatinib as initial therapy, have been excluded from the subsequent analysis, leaving 79 patients treated initially with imatinib 400mg daily. The median age at diagnosis was 53 years (range 13-93) with 40 female and 39 male patients. The median follow up was 75 months (range in living patients 29-163 months). Fifteen patients have died (19%). The median age at diagnosis of these was 73 years. Two deaths were transplant-related, both in patients who had failed available TKIs and had mismatched transplants. The only treated patient who died of accelerated disease was intolerant of all TKIs and unfit for transplant. Three patients died of other malignancies (ovarian, bowel and melanoma). Seven patients were transplanted. Of the surviving 5, 2 had sibling transplants early in the TKI era, 2 had MUD transplants after failing imatinib prior to the availability of second line drugs, and one failed to make an adequate response to imatinib then nilotinib and received a sibling transplant. All surviving transplant patients are in a major molecular response (BCRABL:ABL ratio <0.01, MMR). An MMR was achieved by 60/79 (76%) patients. Of the 19 without MMR, 1 is lost to follow-up, and 9 have died, of which only one death was due to accelerated CML in a patient intolerant of all TKIs. Of those 9 patients living not in MMR, 8 have a CCyR. Three are elderly patients in whom we have taken a pragmatic approach, three are related to patient compliance, two to treatment limited by severe side effects and one had TKI interruption to facilitate cancer treatment. Of the sixty patients in MMR, 40 achieved this on standard dose imatinib. Four patients required increased dose of imatinib, 11 were switched to second line TKI and 5 were transplanted. A complete molecular response (BCRABL:ABL ratio <0.000, CMR) was achieved by 10 patients, six on standard dose imatinib.
Conclusion
This data shows the real life experience of patients treated for CML in the TKI era. At six years follow up, the overall survival was 86% which is remarkably similar to that of the IRIS trial patients. Using an intention to treat analysis in this unselected population, up front imatinib with appropriate escalation of treatment where response is unsatisfactory achieves an MMR rate of 76%. This offers reassurance that where appropriate monitoring is feasible, imatinib remains a good first choice for patients presenting with CML.
Session topic: 8. Chronic myeloid leukemia - Clinical
Keyword(s): Molecular response, imatinib, Chronic myeloid leukemia
Abstract: PB1836
Type: Publication Only
Background
In large trials, patients with chronic myeloid leukaemia (CML) treated with Tyrosine Kinase Inhibitors (TKIs) have relative survival rates of up to 90% that of age-matched controls. Patients achieving complete cytogenetic responses (CCyR) within 2 years of starting Imatinib have survival rates equivalent to the general population. Newer TKIs are associated with faster and deeper treatment responses, but have a more toxic side effect profile as well as being more costly.
Aims
This study looks at the 11 year experience of a single teaching hospital treating a population of almost one million and presents the response and survival data of this unselected population of patients with CML treated with imatinib as initial therapy.
Methods
A retrospective case record review was undertaken on CML patients identified from the regional cytogenetics department. Imatinib was available for routine prescription in the UK from 2003, so a 11-year period from 2003 to 2013 was selected to allow for adequate follow-up.
Results
In total 83 patients were newly diagnosed in this time period. Four patients, treated on SPIRIT2 with dasatinib as initial therapy, have been excluded from the subsequent analysis, leaving 79 patients treated initially with imatinib 400mg daily. The median age at diagnosis was 53 years (range 13-93) with 40 female and 39 male patients. The median follow up was 75 months (range in living patients 29-163 months). Fifteen patients have died (19%). The median age at diagnosis of these was 73 years. Two deaths were transplant-related, both in patients who had failed available TKIs and had mismatched transplants. The only treated patient who died of accelerated disease was intolerant of all TKIs and unfit for transplant. Three patients died of other malignancies (ovarian, bowel and melanoma). Seven patients were transplanted. Of the surviving 5, 2 had sibling transplants early in the TKI era, 2 had MUD transplants after failing imatinib prior to the availability of second line drugs, and one failed to make an adequate response to imatinib then nilotinib and received a sibling transplant. All surviving transplant patients are in a major molecular response (BCRABL:ABL ratio <0.01, MMR). An MMR was achieved by 60/79 (76%) patients. Of the 19 without MMR, 1 is lost to follow-up, and 9 have died, of which only one death was due to accelerated CML in a patient intolerant of all TKIs. Of those 9 patients living not in MMR, 8 have a CCyR. Three are elderly patients in whom we have taken a pragmatic approach, three are related to patient compliance, two to treatment limited by severe side effects and one had TKI interruption to facilitate cancer treatment. Of the sixty patients in MMR, 40 achieved this on standard dose imatinib. Four patients required increased dose of imatinib, 11 were switched to second line TKI and 5 were transplanted. A complete molecular response (BCRABL:ABL ratio <0.000, CMR) was achieved by 10 patients, six on standard dose imatinib.
Conclusion
This data shows the real life experience of patients treated for CML in the TKI era. At six years follow up, the overall survival was 86% which is remarkably similar to that of the IRIS trial patients. Using an intention to treat analysis in this unselected population, up front imatinib with appropriate escalation of treatment where response is unsatisfactory achieves an MMR rate of 76%. This offers reassurance that where appropriate monitoring is feasible, imatinib remains a good first choice for patients presenting with CML.
Session topic: 8. Chronic myeloid leukemia - Clinical
Keyword(s): Molecular response, imatinib, Chronic myeloid leukemia