Imatinib mesylate versus allogeneic hematopoietic stem cell transplantation for patients with chronic myelogenous leukemia in the accelerated phase.

Abstract

The relative merits of allogeneic hematopoietic stem cell transplantation (allo-HSCT) and imatinib for chronic myelogenous leukemia in the accelerated phase (AP-CML) have not previously been evaluated. This cohort study was designed to compare the outcomes of imatinib (n = 87) versus allo-HSCT (n = 45) for AP-CML. A multivariate analysis of the total population revealed that a CML duration ≥ 12 months, hemoglobin < 100 g/L, and peripheral blood blasts ≥ 5% were independent adverse prognostic factors for both overall survival (OS) and progression-free survival (PFS). Both treatments resulted in similar survival in low-risk (no factor) patients, with 6-year event-free survival (EFS), OS, and PFS rates of more than 80.0%. Intermediate-risk (any factor) patients showed no difference in EFS and OS, but 6-year PFS rates were 55.7% versus 92.9% (P = .047) with imatinib versus allo-HSCT, respectively. Among high-risk (at least 2 factors) patients, imatinib was by far inferior to allo-HSCT, with 5-year EFS, OS, and PFS rates of 9.3% versus 66.7% (P = .034), 17.7% versus 100% (P = .008), and 18.8% versus 100% (P = .006), respectively. We conclude that allo-HSCT confers significant survival advantages for high- and intermediate-risk patients with AP-CML compared with imatinib treatment; however, the outcomes of the 2 therapies are equally good in low-risk patients. All trials were registered with the Chinese Clinical Trial Registry (www.chictr.org) as CHiCTR-TNC-10000955.

• Authors: Qian Jiang, Lan-Ping Xu, Dai-Hong Liu, Kai-Yan Liu, Shan-Shan Chen, Bin Jiang, Hao Jiang, Huan Chen, Yu-Hong Chen, Wei Han, Xiao-Hui Zhang, Yu Wang, Ya-Zhen Qin, Yan-Rong Liu, Yue-Yun Lai, Xiao-Jun Huang
• Journal: Blood (Blood) Vol. 117 Issue 11 Pg. 3032-40 (Mar 17 2011) ISSN: 1528-0020 [Electronic] United States
• PMID: 21252092 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antineoplastic Agents
• Benzamides
• Piperazines
• Pyrimidines
• Imatinib Mesylate

Topics

• Adult
• Antineoplastic Agents (therapeutic use)
• Benzamides
• Cohort Studies
• Disease-Free Survival
• Female
• Hematopoietic Stem Cell Transplantation
• Humans
• Imatinib Mesylate
• Leukemia, Myeloid, Accelerated Phase (drug therapy)
• Male
• Middle Aged
• Multivariate Analysis
• Piperazines (therapeutic use)
• Pyrimidines (therapeutic use)
• Risk Factors
• Transplantation, Homologous
• Treatment Outcome
• Young Adult