Is it possible to improve the results of fi rst line therapy for chronic myeloid leukemia in chronic phase?

Abstract

The results of fi rst-line therapy of chronic myeloid leukemia in chronic phase with second generation tyrosine kinase inhibitors (TKI) are superior to imatinib. In DASISION trial after 3-year follow-up compared to imatinib-treated patients, dasatinib-treated patients: achieved higher rates of complete cytogenetic responses (CCyR) (after year: 1 and 2) and major molecular responses (MMR) (after year 1, 2, and 3), responses were achieved much faster, had fewer transformations
to accelerated/blast phase. The same pattern of response was observed within ENESTnd trial by 48 months with higher rates of cytogenetic and molecular responses (MR), which were achieved
faster in nilotinib-treated patients which had fewer transformations to accelerated/blast phase. In DASISION, ENESTnd, Hammersmith study, CML Study IV and SPIRIT II trial patients with
BCR/ABL1 reduction to ≤ 10% after 3 months of TKI therapy had higher rates of CCyR, MMR, MR4, MR4,5 and event-free survival (EFS), progression-free survival (PFS), and overall survival in long-term analysis. Signifi cantly more patients treated with second generation TKI than with imatinib had reduction to ≤ 10% and to ≤ 1%. In another clinical trial a better EFS and PFS for patients who achieved a CMR than for those with CCyR irrespective of MMR status was shown.