High-dose imatinib mesylate therapy in newly diagnosed Philadelphia chromosome–positive chronic phase chronic myeloid leukemia

• Published in: Blood 2004-04, Vol.103 (8), p.2873-2878
• Main Authors: Kantarjian, Hagop, Talpaz, Moshe, O'Brien, Susan, Garcia-Manero, Guillermo, Verstovsek, Srdan, Giles, Francis, Rios, Mary Beth, Shan, Jianqin, Letvak, Laurie, Thomas, Deborah, Faderl, Stefan, Ferrajoli, Alessandra, Cortes, Jorge
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Antineoplastic agents; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - therapeutic use; Benzamides; Biological and medical sciences; Chemotherapy; Drugs, Investigational - administration & dosage; Drugs, Investigational - adverse effects; Drugs, Investigational - therapeutic use; Female; Genes, abl; Hematologic and hematopoietic diseases; Humans; Imatinib Mesylate; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - drug therapy; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - genetics; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Philadelphia Chromosome; Piperazines - administration & dosage; Piperazines - adverse effects; Piperazines - therapeutic use; Pyrimidines - administration & dosage; Pyrimidines - adverse effects; Pyrimidines - therapeutic use; Therapies, Investigational
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2003-11-3800

Imatinib mesylate (STI571) is effective in chronic phase chronic myelogenous leukemia (CML). However, most patients treated with 400 mg imatinib daily have variable levels of residual molecular disease. We treated 114 patients with newly diagnosed chronic phase CML with 400 mg imatinib twice daily. Overall, 109 patients (96%) had a major cytogenetic response (Philadelphia chromosome [Ph] < 35%), and 103 (90%) had a complete response (Ph 0%). With a median follow-up of 15 months, no patient has progressed to accelerated or blastic phase. The estimated 2-year survival rate was 94%. By quantitative polymerase chain reaction (QPCR) studies, 71 (63%) of 112 patients showed BCR-ABL/ABL percentage ratios decrease to less than 0.05%, and 31 (28%) to undetectable levels. Compared with standard-dose imatinib, high-dose imatinib was associated with significantly better complete cytogenetic response (P= .0005), major molecular response (QPRC < 0.05%;P= .00001), and complete molecular response (undetectable BCR-ABL;P= .001). High-dose imatinib was well tolerated but resulted in more frequent myelosuppression; 82% of patients continue to receive 600 mg or more of imatinib daily. In conclusion, high-dose imatinib induced higher rates of complete cytogenetic response and of molecular response in patients with newly diagnosed chronic phase CML. (Blood. 2004; 103:2873-2878)