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Prepublished online as a Blood First Edition Paper on January 30, 2003; DOI 10.1182/blood-2002-09-2790.
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Blood, 15 May 2003, Vol. 101, No. 10, pp. 3794-3800
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Prognostic significance of cytogenetic clonal evolution
in patients with chronic myelogenous leukemia on imatinib
mesylate therapy
Jorge E. Cortes,
Moshe Talpaz,
Francis Giles,
Susan O'Brien,
Mary Beth Rios,
Jianqin Shan,
Guillermo Garcia-Manero,
Stefan Faderl,
Deborah A. Thomas,
William Wierda,
Allessandra Ferrajoli,
Sima Jeha, and
Hagop M. Kantarjian
From the Department of Leukemia and the Department of
Bioimmunotherapy, The University of Texas M. D. Anderson Cancer
Center, Houston, TX.
Cytogenetic clonal evolution (CE) is a known poor prognostic factor
in Philadelphia chromosome-positive chronic myelogenous leukemia
(Ph-positive CML). However, its prognostic relevance in the era of
imatinib therapy is unknown. We investigated the independent prognostic
relevance of CE in 498 patients with Ph-positive CML treated with
imatinib for chronic or accelerated phases. One hundred twenty-one
patients had CE alone (n = 70) or with other accelerated phase
criteria (n = 51). Patients were compared in 4 categories: chronic
phase (n = 295), CE only (n = 70), accelerated phase without CE
(n = 82), and accelerated phase with CE (n = 51). Statistical
methods used established methodologies for univariate and multivariate
analyses. In chronic and accelerated phases of CML, CE was not
associated with significant differences in major or complete
cytogenetic response rates, but it was an independent poor prognostic
factor for survival by multivariate analyses in both chronic
(P = .005) and accelerated phase (P = .03).
Multivariate analyses conducted at the 3-month landmark (including the
3-month cytogenetic response) identified the lack of cytogenetic
response at 3 months to be a stronger independent poor prognostic
factor for survival than CE for both chronic (major cytogenetic
response versus other) and accelerated phase (any cytogenetic response versus other). We conclude that cytogenetic CE is not an important factor for achieving major or complete cytogenetic response with imatinib mesylate therapy, but it is an independent poor prognostic factor for survival in both chronic and accelerated phases of CML. The
3-month cytogenetic response to imatinib mesylate refined the
prognostic relevance of such studies in patients on imatinib mesylate therapy.
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