İmatinib ile tedavi edilen kronik myeloid lösemi hastalarının retrospektif değerlendirilmesi
Abstract
Amaç: Ege Üniversitesi Hematoloji kliniğinde imatinib ile tedavi edilen kronik miyeloid lösemi hastalarının 8 yıllık klinik sonuçlarını değerlendirmektir.
Gereç ve Yöntemler: Bu gözlemsel retrospektif çalışmaya, imatinib ile tedavi edilen 18 yaş üstü 72 kronik faz KML hastası dahil edildi. Blastik veya akselere fazdaki hastalar dışlandı. Klinik, sosyo-demografik ve laboratuvar verileri hasta dosyalarından elde edildi. Tanıdan itibaren 6 ay içinde imatinib ile tedavi edilenler ‘erken kronik faz’ ve en az 6 ay ve sonrasında imatinib tedavisine başlananlar ‘geç kronik faz’ olarak tanımlandı. İmatinib tedavisinin 3., 6., 12. ve 18. aylarındaki hematolojik, moleküler ve sitogenetik yanıtlar kaydedildi. Veri analizi SPSS sürüm 16.0 kullanılarak yapıldı.
Bulgular: İmatinib ile 3. ayda hematolojik yanıt %80,5 iken, sonraki aylarda %94,7'ye yükseldi. Hastaların %80'inde 12 ay içinde tam sitogenetik remisyon (CCyR) sağlandı. Genel yanıt oranı %83,3'tü ve medyan takip süresi 10 yıldı. Olumsuz olayların görülme sıklığı %30,5'ti ve çoğunlukla ödem ve cilt değişiklikleri gibi hematolojik olmayan toksisiteleri içeriyordu. Olumsuz olaylara rağmen imatinib, ikinci nesil tirozin kinaz inhibitörlerine kıyasla önemli klinik faydalar gösterdi.
Sonuç: Çalışmamızın tasarlanmasının üzerinden on yıldan fazla zaman geçmesine rağmen imatinib kronik miyeloid lösemi (KML) tedavisinde temel bir rol oynamaya devam etmektedir. İmatinib, yüksek yanıt oranları, maliyet etkinliği ve yönetilebilir toksisiteleri ile KML için hala etkili bir birinci basamak tedavidir.
References
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- Baccarani M, Deininger MW, Rosti G, et al. European LeukemiaNet recommendations for the management of chronic myeloid leukemia: 2013. Blood. 2013;122(6):872-884.
- O'Brien SG, Guilhot F, Larson RA, et al. Imatinib compared with interferon and low-dose cytarabine for newly diagnosed chronic-phase chronic myeloid leukemia. N Engl J Med. 2003;348(11):994-1004.
- Saglio G, Kim DW, Issaragrisil S, et al. Nilotinib versus imatinib for newly diagnosed chronic myeloid leukemia. N Engl J Med. 2010;362(24):2251-2259.
- Kantarjian H, Shah NP, Hochhaus A, et al. Dasatinib versus imatinib in newly diagnosed chronic-phase chronic myeloid leukemia. N Engl J Med. 2010;362(24):2260-2270.
- Cortes JE, Gambacorti-Passerini C, Deininger MW, et al. Bosutinib Versus Imatinib for Newly Diagnosed Chronic Myeloid Leukemia: Results From the Randomized BFORE Trial. J Clin Oncol. 2018;36(3):231-237.
- Baccarani M, Rosti G, Castagnetti F, et al. Comparison of imatinib 400 mg and 800 mg daily in the front-line treatment of high-risk, Philadelphia-positive chronic myeloid leukemia: a European LeukemiaNet Study. Blood. 2009;113(19):4497-4504.
- Cortes JE, Baccarani M, Guilhot F, et al. Phase III, randomized, open-label study of daily imatinib mesylate 400 mg versus 800 mg in patients with newly diagnosed, previously untreated chronic myeloid leukemia in chronic phase using molecular end points: tyrosine kinase inhibitor optimization and selectivity study. J Clin Oncol. 2010;28(3):424-430.
- Kalmanti L, Saussele S, Lauseker M, et al. Safety and efficacy of imatinib in CML over a period of 10 years: data from the randomized CML-study IV. Leukemia. 2015;29(5):1123-1132.
- Hantel A, Larson RA. Imatinib is still recommended for frontline therapy for CML. Blood Adv. 2018;2(24):3648-3652.
- Waller CF. Imatinib mesylate. Recent Results Cancer Res. 2014;201:1-25.
- Hehlmann R, Lauseker M, Saußele S, et al. Assessment of imatinib as first-line treatment of chronic myeloid leukemia: 10-year survival results of the randomized CML study IV and impact of non-CML determinants. Leukemia. 2017;31(11):2398-2406.
A retrospective evaluation of chronic myeloid leukemia patients treated with imatinib
Abstract
Aim: The study aimed to evaluate the clinical outcomes of chronic myeloid leukemia (CML) patients treated with imatinib at Ege University Department of Hematology over an eight-year period.
Material and Methods: This observational retrospective study included 72 chronic phase CML patients aged over 18 years, treated with imatinib. Patients in the blastic or accelerated phases were excluded. Clinical, socio-demographic, and laboratory data were collected from the patient files. Patients were divided as early chronic phase (treated with imatinib within 6 months of diagnosis) and late chronic phase (started imatinib therapy at least 6 months after diagnosis). Hematologic, molecular, and cytogenetic responses at 3, 6, 12, and 18 months of imatinib therapy were recorded. Data analysis was performed using SPSS version 16.0.
Results: Hematologic response at 3 months with imatinib was 80.5%, increasing to 94.7% at following months. Complete cytogenetic remission (CCyR) was achieved in 80% of patients within the 12 months. Overall response rate was 83.3% with a median follow-up of 10 years. The incidence of adverse events was 30.5%, compromising mostly non-hematologic toxicities such as edema and skin changes. Despite the adverse events, imatinib demonstrated significant clinical benefits comparable to second-generation tyrosine kinase inhibitors (TKIs).
Conclusion: Over a decade has passed since our study was designed, yet imatinib continues to be a cornerstone in the treatment of chronic myeloid leukemia (CML). Imatinib is still an effective frontline therapy for CML, with high response rates, cost-effectivity and manageable toxicities.
References
- Rudolf Virchow (1821-1902). CA Cancer J Clin. 1975;25(2):91-92.
- Bartram CR, de Klein A, Hagemeijer A, et al. Translocation of c-ab1 oncogene correlates with the presence of a Philadelphia chromosome in chronic myelocytic leukaemia. Nature. 1983;306(5940):277-280.
- Heisterkamp N, Stephenson JR, Groffen J, et al. Localization of the c-ab1 oncogene adjacent to a translocation break point in chronic myelocytic leukaemia. Nature. 1983;306(5940):239-242.
- Khoury JD, Solary E, Abla O, et al. The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Myeloid and Histiocytic/Dendritic Neoplasms. Leukemia. 2022;36(7):1703-1719.
- Hukku S, Baboo HA, Venkataratnam S, Vidyasagar MS, Patel NL. Splenic irradiation in chronic myeloid leukemia. Acta Radiol Oncol. 1983;22(1):9-12.
- Morstyn G, Sullivan J, Fairhead S, Cowling D, Hurley T. Effects of high dose busulphan on leukaemic progenitor cells in chronic myeloid leukaemia. Aust N Z J Med. 1981;11(6):609-614.
- Kennedy BJ. Hydroxyurea therapy in chronic myelogenous leukemia. Cancer. 1972;29(4):1052-1056.
- Talpaz M, McCredie K, Kantarjian H, Trujillo J, Keating M, Gutterman J. Chronic myelogenous leukaemia: haematological remissions with alpha interferon. Br J Haematol. 1986;64(1):87-95.
- 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(5):561-566.
- Buchdunger E, Zimmermann J, Mett H, et al. Inhibition of the Abl protein-tyrosine kinase in vitro and in vivo by a 2-phenylaminopyrimidine derivative. Cancer Res. 1996;56(1):100-104.
- Baccarani M, Deininger MW, Rosti G, et al. European LeukemiaNet recommendations for the management of chronic myeloid leukemia: 2013. Blood. 2013;122(6):872-884.
- O'Brien SG, Guilhot F, Larson RA, et al. Imatinib compared with interferon and low-dose cytarabine for newly diagnosed chronic-phase chronic myeloid leukemia. N Engl J Med. 2003;348(11):994-1004.
- Saglio G, Kim DW, Issaragrisil S, et al. Nilotinib versus imatinib for newly diagnosed chronic myeloid leukemia. N Engl J Med. 2010;362(24):2251-2259.
- Kantarjian H, Shah NP, Hochhaus A, et al. Dasatinib versus imatinib in newly diagnosed chronic-phase chronic myeloid leukemia. N Engl J Med. 2010;362(24):2260-2270.
- Cortes JE, Gambacorti-Passerini C, Deininger MW, et al. Bosutinib Versus Imatinib for Newly Diagnosed Chronic Myeloid Leukemia: Results From the Randomized BFORE Trial. J Clin Oncol. 2018;36(3):231-237.
- Baccarani M, Rosti G, Castagnetti F, et al. Comparison of imatinib 400 mg and 800 mg daily in the front-line treatment of high-risk, Philadelphia-positive chronic myeloid leukemia: a European LeukemiaNet Study. Blood. 2009;113(19):4497-4504.
- Cortes JE, Baccarani M, Guilhot F, et al. Phase III, randomized, open-label study of daily imatinib mesylate 400 mg versus 800 mg in patients with newly diagnosed, previously untreated chronic myeloid leukemia in chronic phase using molecular end points: tyrosine kinase inhibitor optimization and selectivity study. J Clin Oncol. 2010;28(3):424-430.
- Kalmanti L, Saussele S, Lauseker M, et al. Safety and efficacy of imatinib in CML over a period of 10 years: data from the randomized CML-study IV. Leukemia. 2015;29(5):1123-1132.
- Hantel A, Larson RA. Imatinib is still recommended for frontline therapy for CML. Blood Adv. 2018;2(24):3648-3652.
- Waller CF. Imatinib mesylate. Recent Results Cancer Res. 2014;201:1-25.
- Hehlmann R, Lauseker M, Saußele S, et al. Assessment of imatinib as first-line treatment of chronic myeloid leukemia: 10-year survival results of the randomized CML study IV and impact of non-CML determinants. Leukemia. 2017;31(11):2398-2406.
Details
| Primary Language | English |
|---|---|
| Subjects | Haematological Tumours |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | September 8, 2025 |
| Submission Date | February 12, 2025 |
| Acceptance Date | April 25, 2025 |
| Published in Issue | Year 2025 Volume: 64 Issue: 3 |
