Suboptimal responses in chronic myeloid leukemia: implications and management strategies.
Bottom Line: In 2006, the European LeukemiaNet proposed criteria to identify patients with a suboptimal response to, or failure associated with, imatinib; these recommendations were updated in 2009.Although they may respond to continued imatinib therapy, their long-term outcomes may not be as favorable as those for optimally responding patients.Validation studies demonstrated that suboptimal responders are a heterogeneous group, and that the prognostic implications of suboptimal response vary by time point.
Affiliation: Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA. email@example.comShow MeSH
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Mentions: Marin and colleagues from the Hammersmith Hospital have shown that the degree of patient adherence to imatinib is critical in achieving major molecular response.35 These investigators examined adherence patterns during a 3-month period in 87 patients with complete cytogenetic response who had been receiving imatinib for a median of approximately 5 years. Highly adherent patients (those who took >90% of medication as prescribed) had a significantly higher 6-year probability of achieving major molecular response than did less-adherent patients (94% vs 14%, respectively; P < .001 [Fig. .1]). Furthermore, patients who were highly adherent, even if they did not achieve major molecular response by 12 or 18 months, had a high probability of eventually achieving major molecular response.35 The authors performed a univariate analysis of several variables—patient age, sex, weight, plasma imatinib level, percent adherence, and Sokal risk group—and found that adherence was the only independent predictor for major molecular response. Clearly, adherence is an important parameter to investigate among patients with suboptimal response to TKI treatment.
Affiliation: Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA. firstname.lastname@example.org