Hagop M. Kantarjian, MD; Terry L. Smith, MS; Susan O'Brien, MD; Miloslav Beran, MD, PhD; Sherry Pierce, RN; Moshe Talpaz, MD; The Leukemia Service*
To determine whether a cytogenetic response after interferon-α therapy in patients with chronic myelogenous leukemia is independently associated with improved survival.
274 patients with a diagnosis of Philadelphia chromosome-positive chronic myelogenous leukemia in early chronic phase who were treated with interferon-α-based programs between 1982 and 1990.
Therapy with daily subcutaneous interferon-α given at 5 × 106 U/m2 body surface area (highest dose schedule allowed on studies) or the maximally tolerated lower-dose schedule.
Overall, 219 (80%) patients achieved a complete hematologic response and 104 (38%) achieved a major cytogenetic response (<35% Philadelphia chromosome-positive cells). Estimated median survival was 89 months. Several pretreatment factors were associated with failure to achieve a major cytogenetic response and with worse survival. The existing prognostic models were generally predictive of which patients were likely to achieve a major cytogenetic response (P ≤ 0.01) and of survival outcomes (P ≤ 0.01). Multivariate analysis identified bone marrow basophilia (P < 0.01) and splenomegaly (P < 0.01) as independent poor prognostic factors for survival. Achievement of a major cytogenetic response, entered as a time-dependent variable while accounting for the other independent factors, was associated with improved survival (P < 0.001). Comparison of survival (dated from 12 months into therapy) with cytogenetic response at 12 months showed that a cytogenetic response was associated with longer survival (P < 0.001).
Achieving a cytogenetic response with interferon-α therapy in patients with chronic myelogenous leukemia was independently associated with improved survival when tested as a time-dependent variable in a multivariate analysis, and this association was confirmed by landmark analysis at 12 months.
*For members of the Leukemia Service, see Appendix.
Kantarjian HM, Smith TL, O'Brien S, Beran M, Pierce S, Talpaz M, et al. Prolonged Survival in Chronic Myelogenous Leukemia after Cytogenetic Response to Interferon-α Therapy. Ann Intern Med. 1995;122:254–261. doi: 10.7326/0003-4819-122-4-199502150-00003
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Published: Ann Intern Med. 1995;122(4):254-261.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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