The results of 12 years treatment of patients in late chronic phase of chronic myeloid leukemia by tyrosine kinase inhibitors after failure IFN-α
Abstract
Expanding the range of tyrosine kinase inhibitors (TKI) from the 1st (imatinib) to 2nd generation (nilotinib, dasatinib, bosutinib) allows achieving the suppression of Ph′-positive leukemia clone in the treatment of patients with chronic myeloid leukemia (CML). The aim of our study was to evaluate the results of 12 years treatment by TKIs of the 1st and 2nd generation of patients in late chronic phase (CP) CML including the overall survival (OS) and progression-free survival, mortality in the group structure. Overall 12-year survival was 68 %, progression-free survival was 66 %. The annual mortality from progression of CML remains unchanged during the last 3 years – 1.3 % occurrences per year. The death main cause remains the progression of CML. Achieving of the complete cytogenetic response (CCyR) for various periods of therapy by TKIs of the 1st and 2nd generation was observed in 54 (68 %) patients, firstly CCyR was obtained in 10 (30 %) of 34 patients due to therapy change to the TKI of the 2nd generation. The OS in patients with CCyR at 12 months of TKI-1 was 90 % versus 67 % in patients without response to this term (p = 0.05). The mortality of patients without the CCyR was 80 %. The possibility of stable recovery of residual clone Ph′-negative cells has been revealed in the group of patients in late CP CML with poor prognosis (resistance and intolerance to IFN). It is associated with the increase in OS and progression-free survival. Considering the possibility of long-term molecular remission during therapy by TKIs, it is necessary to develop the program on conducting remission without maintenance treatment in patients with complete molecular response. The interruption of TKIs intake without deep stable molecular response is dangerous for patients and may lead to the progression of CML up to death.
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Lazareva O.V. – candidate of medical sciences, researcher of the scientific advisory department of chemotherapy myeloproliferative disorders, e-mail: stakhino@gmail.com
Turkina A.G. – doctor of medical sciences, professor, head of the scientific advisory department chemotherapy myeloproliferative disorders, e-mail: turkianna@yandex.ru
Gusarova G.A. – candidate of medical sciences, senior researcher of the scientific advisory department chemotherapy myeloproliferative disorders, e-mail: galina1966@bk.ru
Chelysheva E.Yu. – candidate of medical sciences, senior researcher of the scientific advisory department chemotherapy myeloproliferative disorders, e-mail: denve@bk.ru
Zakharova E.S. – candidate of medical sciences, doctor-hematologist