Has the time for first-line treatment with second generation tyrosine kinase inhibitors in patients with chronic myelogenous leukemia already come? Systematic review and meta-analysis

Gurion, Ronit; Gafter‐Gvili, Anat; Vidal, Liat; Leader, Avi; Ram, Ron; Shacham-Abulafia, Adi; Paul, Mical; Ben‐Bassat, Isaac; Shpilberg, Ofer; Raanani, Pia

doi:10.3324/haematol.2012.063172

Cited by 29 publications

(26 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One point is the choice of the first TKI. [162][163][164] Two trials have shown an initial superiority of second-generation TKIs vs imatinib, with significant differences in response but not yet in outcome. [9][10][11][12][13] They justify placing nilotinib and dasatinib in the front-line setting but do not justify the exclusion of imatinib.…”

Section: Discussionmentioning

confidence: 99%

European LeukemiaNet recommendations for the management of chronic myeloid leukemia: 2013

Baccarani

Deininger

Rosti

et al. 2013

Blood

1,755

2,099

View full text Add to dashboard Cite

Advances in chronic myeloid leukemia treatment, particularly regarding tyrosine kinase inhibitors, mandate regular updating of concepts and management. A European LeukemiaNet expert panel reviewed prior and new studies to update recommendations made in 2009. We recommend as initial treatment imatinib, nilotinib, or dasatinib. Response is assessed with standardized real quantitative polymerase chain reaction and/or cytogenetics at 3, 6, and 12 months. BCR-ABL1 transcript levels ≤10% at 3 months, <1% at 6 months, and ≤0.1% from 12 months onward define optimal response, whereas >10% at 6 months and >1% from 12 months onward define failure, mandating a change in treatment. Similarly, partial cytogenetic response (PCyR) at 3 months and complete cytogenetic response (CCyR) from 6 months onward define optimal response, whereas no CyR (Philadelphia chromosome–positive [Ph+] >95%) at 3 months, less than PCyR at 6 months, and less than CCyR from 12 months onward define failure. Between optimal and failure, there is an intermediate warning zone requiring more frequent monitoring. Similar definitions are provided for response to second-line therapy. Specific recommendations are made for patients in the accelerated and blastic phases, and for allogeneic stem cell transplantation. Optimal responders should continue therapy indefinitely, with careful surveillance, or they can be enrolled in controlled studies of treatment discontinuation once a deeper molecular response is achieved.

show abstract

Section: Discussionmentioning

confidence: 99%

European LeukemiaNet recommendations for the management of chronic myeloid leukemia: 2013

Baccarani

Deininger

Rosti

et al. 2013

Blood

1,755

2,099

View full text Add to dashboard Cite

show abstract

“…To achieve and to maintain these goals, it is possible to choose among several TKIs, and a chronic, lifelong treatment is required. However, the scenario is changing, the goal is moving from survival to cure, and the treatment policies are moving towards discontinuation [1,6,7,[56][57][58]. The next goal is to achieve a condition of treatmentfree remission (TFR) [59][60][61].…”

Section: Management Of CML Evolution Of Goals and Strategiesmentioning

confidence: 97%

A review of the European LeukemiaNet recommendations for the management of CML

et al. 2015

View full text Add to dashboard Cite

Several guidelines and recommendations on the management of chronic myeloid leukemia (CML) have been prepared by several scientific societies. The European LeukemiaNet (ELN) appointed a panel of experts who submitted their recommendations to peer-reviewed scientific journals in 2006, 2009, and 2013. Here, we make a critical review of the last, 2013, ELN recommendations, concerning the use of the five available tyrosine kinase inhibitors (TKIs), the evaluation of cytogenetic and molecular response, and the strategy of treatment. Three TKIs (imatinib, nilotinib, dasatinib) are recommended first-line. Bosutinib and ponatinib are available second-line; ponatinib is particularly indicated in case of the T315I mutation. Achieving an optimal response, not only for survival but also for a deeper, stable, treatment-free remission, requires a BCR-ABL transcripts level ≤ 10 % at 3 months, ≤ 1 % at 6 months, ≤ 0.1 % at 1 year, and ≤ 0.01 % later on. Molecular monitoring must include mutational analysis in every case of failure. A successful treatment of accelerated and blastic phase requires TKIs, and in many cases also allogeneic stem cell transplantation.

show abstract

“…The overall pooled OR and 95% CI were estimated using the Mantel-Haenszel method with a fixed-effect model when no significant clinical or statistical heterogeneity was pres-ent (P ≥ 0.10) (Gurion et al, 2013). When substantial heterogeneity was present, the randomeffect model was used.…”

Section: Discussionmentioning

confidence: 99%

Cyclin D1 G870A gene polymorphism and risk of leukemia and hepatocellular carcinoma: a meta-analysis

Zhao¹,

He²,

Wang³

et al. 2015

Genet. Mol. Res.

View full text Add to dashboard Cite

ABSTRACT. Cyclin D1 (CCND1) is a key protein involved in cellcycle regulation, and the CCND1 G870A polymorphism is associated with many types of malignancy. Studies examining the associations between this G870A polymorphism and susceptibility to leukemia and hepatocellular carcinoma (HCC) have shown inconsistent results. Therefore, we conducted a meta-analysis to clarify these associations. A search of the PubMed database yielded 7 relevant articles: 3 pertaining to leukemia and 4 to HCC. The odds ratios (ORs) from individual studies were pooled using a fixed or random-effect model. A significant association was observed between the CCND1 G870A variant and leukemia under the allele contrast model [P = 0.003, OR = 1.49, 95% confidence interval (CI) = 1.15-1.95], the homozygote contrast model (P = 0.003, OR = 2.30, 95%CI = 1.34-3.96), and the recessive model (P = 0.002, OR = 2.03, 95%CI = 1.29-3.21). A significant association was observed between this variant and HCC under the recessive model (P = Y. Zhao et al. 5172©FUNPEC-RP www.funpecrp.com.br Genetics and Molecular Research 14 (2): 5171-5180 (2015) 0.0006, OR = 1.62, 95%CI = 1.23-2.14), the dominant model (P = 0.002, OR = 1.59, 95%CI = 1.19-2.14), the homozygote contrast model (P < 0.0001, OR = 2.06, 95%CI = 1.45-2.94), and the allele contrast model (P < 0.0001, OR = 1.43, 95%CI = 1.20-1.69). Our findings suggest that heritable CCND1 status may influence the risk of developing leukemia and HCC, and that more attention should be given to carriers of these susceptibility genes.

show abstract

Has the time for first-line treatment with second generation tyrosine kinase inhibitors in patients with chronic myelogenous leukemia already come? Systematic review and meta-analysis

Cited by 29 publications

References 49 publications

European LeukemiaNet recommendations for the management of chronic myeloid leukemia: 2013

European LeukemiaNet recommendations for the management of chronic myeloid leukemia: 2013

A review of the European LeukemiaNet recommendations for the management of CML

Cyclin D1 G870A gene polymorphism and risk of leukemia and hepatocellular carcinoma: a meta-analysis

Contact Info

Product

Resources

About