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Follow-up of complete cytogenetic remission in patients with chronic myeloid leukemia after cessation of interferon alfa.

AbstractPURPOSE:
A small proportion of patients with chronic myeloid leukemia (CML) achieve a complete cytogenetic response (CCR), defined as the disappearance of Philadelphia (Ph) chromosome-positive metaphases, after treatment with interferon alfa (IFN). In this population of patients, the question of whether treatment should then be withdrawn is not yet resolved.
PATIENTS AND METHODS:
In the present study, we followed 15 patients who stopped IFN after achieving CCR. In nine patients IFN was stopped in view of adverse reactions (n = 8) or patient's choice (n = 1). For the remaining six patients, the treatment was stopped because no BCR/ABL rearrangement could be detected by reverse transcriptase polymerase chain reaction (RT-PCR) in four successive analyses using peripheral-blood samples.
RESULTS:
Loss of CCR and survival were not statistically different (P =.48; P =.7) for the 15 patients who stopped IFN compared with 41 other CCR patients who continued IFN therapy in our institution. The median follow-up after discontinuation of IFN treatment was 36 months (range, 6 to 108 months). Seven patients (47%) (females, or CCR > 24 months and RT-PCR negative before IFN cessation; P <.0001) did not relapse. Eight other patients (53%) relapsed (lost CCR) within 3 to 33 months of treatment discontinuation. One of them relapsed in major cytogenetic remission (MCR) and was still in MCR 87 months after stopping therapy without any treatment.
CONCLUSION:
It is possible to stop IFN treatment at least in some patients with CML who achieve a prolonged period of CCR. This study also illustrates the hypothesis that persistence of low numbers of Ph-positive cells does not necessarily imply hematologic relapse.
AuthorsF X Mahon, X Delbrel, P Cony-Makhoul, C Fabères, J M Boiron, C Barthe, C Bilhou-Nabéra, A Pigneux, G Marit, J Reiffers
JournalJournal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 20 Issue 1 Pg. 214-20 (Jan 01 2002) ISSN: 0732-183X [Print] United States
PMID11773172 (Publication Type: Journal Article)
Chemical References
  • Antineoplastic Agents
  • Interferon-alpha
  • Fusion Proteins, bcr-abl
Topics
  • Adult
  • Aged
  • Antineoplastic Agents (administration & dosage, adverse effects)
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • Fusion Proteins, bcr-abl (blood, genetics)
  • Humans
  • Interferon-alpha (administration & dosage, adverse effects)
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive (drug therapy, mortality)
  • Male
  • Middle Aged
  • Recurrence
  • Remission Induction
  • Risk Factors
  • Statistics, Nonparametric
  • Survival Rate
  • Time Factors

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