A new prognostic score for survival of patients with chronic myeloid leukemia treated with interferon alfa. Writing Committee for the Collaborative CML Prognostic Factors Project Group.
Joerg Hasford,Markus Pfirrmann,Rüdiger Hehlmann,N. C. Allan,Michele Baccarani,J. C. Kluin-Nelemans,Guiliana Alimena,Juan Luis Steegmann,H. Ansari +8 more
TLDR
A new prognostic scoring system for estimating survival of patients with CML treated with interferon alfa has been developed and validated through use of a large dataset and the ability of the new scoring system to discriminate risk groups was confirmed.Abstract:
BACKGROUND:
Interferon alfa is a conservative and widely used alternative to bone marrow transplantation in treatment of patients with early chronic myeloid leukemia (CML). A meta-analysis was conducted to develop a reliable prognostic scoring system for estimation of survival of patients with CML treated with interferon alfa.
METHODS:
Patients treated in prospective studies, including major randomized trials, were separated into learning and validation samples. Cox regression analysis and the minimum P-value approach were used to identify prognostic factors for patient survival and to discover groups in the learning sample with the greatest differences in survival. These findings were then validated by applying the new scoring system to patients in the validation sample.
RESULTS:
We collected data on 1573 patients who were participants in 14 studies involving 12 institutions; 1303 patients (learning sample, n = 981; validation sample, n = 322) were eligible for inclusion in this analysis, and their median survival time was 69 months (range, 1-117 months). Because two previously described prognostic scoring systems failed to discriminate risk groups satisfactorily, we developed a new scoring system that utilizes the following covariates: age, spleen size, blast count, platelet count, eosinophil count, and basophil count. Among 908 patients with complete data in the learning sample, three distinct risk groups were identified (median survival times of 98 months [n = 369; 40.6%], 65 months [n = 406; 44.7%], or 42 months [n = 133;14.6%]; two-sided logrank test, P< or =.0001). The ability of the new scoring system to discriminate these risk groups was confirmed by analysis of 285 patients with complete data in the validation sample (two-sided logrank test, P = .0002).
CONCLUSIONS:
A new prognostic scoring system for estimating survival of patients with CML treated with interferon alfa has been developed and validated through use of a large dataset.read more
Citations
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Imatinib compared with interferon and low-dose cytarabine for newly diagnosed chronic-phase chronic myeloid leukemia
Stephen G. O'Brien,François Guilhot,Richard A. Larson,Insa Gathmann,Michele Baccarani,Francisco Cervantes,Jan J. Cornelissen,Thomas Fischer,Andreas Hochhaus,Timothy P. Hughes,Klaus Lechner,Johan Lanng Nielsen,Philippe Rousselot,Josy Reiffers,Giuseppe Saglio,John D. Shepherd,Bengt Simonsson,Alois Gratwohl,John M. Goldman,Hagop M. Kantarjian,Kerry Taylor,Gregor Verhoef,Ann E. Bolton,Renaud Capdeville,Brian J. Druker +24 more
TL;DR: Imatinib was superior to interferon alfa plus low-dose cytarabine as first-line therapy in newly diagnosed chronic-phase CML and was better tolerated than combination therapy.
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European LeukemiaNet recommendations for the management of chronic myeloid leukemia: 2013
Michele Baccarani,Michael W. Deininger,Gianantonio Rosti,Andreas Hochhaus,Simona Soverini,Jane F. Apperley,Francisco Cervantes,Richard E. Clark,Jorge E. Cortes,François Guilhot,Henrik Hjorth-Hansen,Timothy P. Hughes,Hagop M. Kantarjian,Dong-Wook Kim,Richard A. Larson,Jeffrey H. Lipton,François Xavier Mahon,Giovanni Martinelli,Jiri Mayer,Martin C. Müller,Dietger Niederwieser,Fabrizio Pane,Jerald P. Radich,Philippe Rousselot,Giuseppe Saglio,Susanne Saußele,Charles A. Schiffer,Richard T. Silver,Bengt Simonsson,Juan Luis Steegmann,John M. Goldman,Rüdiger Hehlmann +31 more
TL;DR: Optimal responders to chronic myeloid leukemia treatment should continue therapy indefinitely, with careful surveillance, or they can be enrolled in controlled studies of treatment discontinuation once a deeper molecular response is achieved.
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Clinical practice guidelines in oncology
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TL;DR: This manuscript focuses on the NCCN Guidelines Panel recommendations for the workup, primary treatment, risk reduction strategies, and surveillance specific to DCIS.
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Dasatinib versus imatinib in newly diagnosed chronic-phase chronic myeloid leukemia.
Hagop M. Kantarjian,Neil P. Shah,Andreas Hochhaus,Jorge E. Cortes,Sandip Shah,Manuel Ayala,Beatriz Moiraghi,Zhixiang Shen,Jiri Mayer,Ricardo Pasquini,Hirohisa Nakamae,Françoise Huguet,Concepción Boqué,Charles Chuah,Eric Bleickardt,M. Brigid Bradley-Garelik,Chao Zhu,Ted Szatrowski,David Shapiro,Michele Baccarani +19 more
TL;DR: Since achieving complete cytogenetic response within 12 months has been associated with better long-term, progression-free survival, dasatinib may improve the long- term outcomes among patients with newly diagnosed chronic-phase CML.
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Frequency of Major Molecular Responses to Imatinib or Interferon Alfa plus Cytarabine in Newly Diagnosed Chronic Myeloid Leukemia
Timothy P. Hughes,Jaspal Kaeda,Susan Branford,Zbigniew Rudzki,Andreas Hochhaus,Martee L. Hensley,Insa Gathmann,Ann E. Bolton,Iris C. van Hoomissen,John M. Goldman,Jerald P. Radich +10 more
TL;DR: The proportion of patients with CML who had a reduction in BCR-ABL transcript levels of at least 3 log by 12 months of therapy was far greater with imatinib treatment than with treatment with interferon plus cytarabine.
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