Younger patients with chronic myeloid leukemia do well in spite of poor prognostic indicators: results from the randomized CML study IV

Lida Kalmanti; Susanne Saussele; Michael Lauseker; Ulrike Proetel; Martin C Müller; Benjamin Hanfstein; Annette Schreiber; Alice Fabarius; Markus Pfirrmann; Susanne Schnittger; Jolanta Dengler; Christiane Falge; Lothar Kanz; Andreas Neubauer; Frank Stegelmann; Michael Pfreundschuh; Cornelius F Waller; Karsten Spiekermann; Stefan W Krause; Dominik Heim; Christoph Nerl; Dieter K Hossfeld; Hans-Jochem Kolb; Andreas Hochhaus; Joerg Hasford; Rüdiger Hehlmann; German Chronic Myeloid Leukemia Study Group; Schweizerische Arbeitsgemeinschaft für Klinische Krebsforschung (SAKK)

doi:10.1007/s00277-013-1937-4

Younger patients with chronic myeloid leukemia do well in spite of poor prognostic indicators: results from the randomized CML study IV

Ann Hematol. 2014 Jan;93(1):71-80. doi: 10.1007/s00277-013-1937-4. Epub 2013 Oct 27.

Affiliation

¹ III. Medizinische Klinik, Universitätsmedizin Mannheim, Pettenkoferstrasse 22, 68169, Mannheim, Germany.

Abstract

Since the advent of tyrosine kinase inhibitors, the impact of age on outcome of chronic myeloid leukemia (CML) patients has changed. We therefore analyzed patients from the randomized CML study IV to investigate disease manifestations and outcome in different age groups. One thousand five hundred twenty-four patients with BCR-ABL-positive chronic phase CML were divided into four age groups: (1) 16-29 years, n = 120; (2) 30-44 years, n = 383; (3) 45-59 years, n = 495; and (4) ≥60 years, n = 526. Group 1 (adolescents and young adults (AYAs)) presented with more aggressive disease features (larger spleen size, more frequent symptoms of organomegaly, higher white blood count, higher percentage of peripheral blasts and lower hemoglobin levels) than the other age groups. In addition, a higher rate of patients with BCR-ABL transcript levels >10 % on the international scale (IS) at 3 months was observed. After a median observation time of 67.5 months, no inferior survival and no differences in cytogenetic and molecular remissions or progression rates were observed. We conclude that AYAs show more aggressive features and poor prognostic indicators possibly indicating differences in disease biology. This, however, does not affect outcome.

Trial registration: ClinicalTrials.gov NCT00055874.

Publication types

Comparative Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Age Factors
Aged
Antineoplastic Combined Chemotherapy Protocols / therapeutic use
Benzamides / administration & dosage
Benzamides / therapeutic use
Cytarabine / administration & dosage
Female
Follow-Up Studies
Fusion Proteins, bcr-abl / blood
Fusion Proteins, bcr-abl / genetics
Humans
Imatinib Mesylate
Interferon-alpha / administration & dosage
Kaplan-Meier Estimate
Karnofsky Performance Status
Leukemia, Myeloid, Chronic-Phase / blood
Leukemia, Myeloid, Chronic-Phase / drug therapy
Leukemia, Myeloid, Chronic-Phase / genetics
Leukemia, Myeloid, Chronic-Phase / mortality*
Male
Middle Aged
Piperazines / administration & dosage
Piperazines / therapeutic use
Protein Kinase Inhibitors / administration & dosage
Protein Kinase Inhibitors / therapeutic use
Pyrimidines / administration & dosage
Pyrimidines / therapeutic use
RNA, Messenger / blood
RNA, Neoplasm / blood
Randomized Controlled Trials as Topic / statistics & numerical data
Risk Factors
Splenomegaly / etiology
Treatment Outcome
Young Adult

Substances

Benzamides
Interferon-alpha
Piperazines
Protein Kinase Inhibitors
Pyrimidines
RNA, Messenger
RNA, Neoplasm
Cytarabine
Imatinib Mesylate
Fusion Proteins, bcr-abl

Associated data

ClinicalTrials.gov/NCT00055874