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P030 Chronic myelogenous leukemia Casablanca experience retrospective study about 431 cases
S78
Poster Sessions
for careful monitoring of response to treatment with tyrosine kinase inhibitors in order to ensure that an individual patient receives the proper treatment and to decide if and when a therapy should be changed.
P029 Treatment of chronic myeloid leukemia with interferon and imatinib: results from the northern Moravia E. Faber, J. Zapletalová, I. Skoumalová, Š. Rožmanová, M. Holzerová, P. Rohoˇn, J. Veselovská, R. Solná, I. Marešová, N. Klusová, V. Divoký, M. Jarošová, K. Indrák. Department of Hemato-Oncology, University Hospital Olomouc, Olomouc, Czech Republic We report the results of CML treatment with interferon (IF) and imatinib (IM) in the Northern Moravia region. 38 (36%) of 107 patients (aged 19-71; median 49) treated with IF have achieved major or better cytogenetic response (CR). OS of patients treated with IF (median 99 months) was significantly influenced by Sokal score and achievement of the significant CR (p= 0,0031 and 0,0063). However, only 9 (8%) patients are continuing in IF therapy at present. Nearly half of the patients have stopped the treatment due to the primary resistance. Secondary resistance and intolerance were the cause in 27% and 13% of patients, respectively. On the other hand, 6 patients have stopped IF therapy after achievement of molecular response that has been continuing from 9 to 71 months. Treatment with IM was evaluated in 102 patients aged 17 to 78 years (median 52). 86 patients have started the therapy in chronic phase, 14 in acceleration and 2 in blastic phase. Interval from diagnosis to initiation of IM treatment ranged from 1 to 135 months (me 9). 28 patients were treated with IM early after diagnosis, 4 were pretreated with oral chemotherapy only and 70 patients with IF. IM was indicated due to intolerance of IF in 14 cases and because of hematologic or cytogenetic resistance to IF in 20 and 36 patients, respectively. Median duration of therapy was 34,3 months with range 0,36-73,7 months. Median follow-up of patients since diagnosis was 46,5 months with range from 7 to 207 months. 96 patients were evaluated for CR and molecular response. Complete CR was achieved in 73 (76%) patients; 24 (25%) of them achieved more than 3-log reduction in quantitative RTPCR assessment while 26 (27%) patients have achieved negativity in nested RT-PCR. Using Cox regression analysis phase of CML at initiation of IM, Sokal score and interval from diagnosis to the start of therapy were as factors associated with response to IM, OS and PFS of patients (p=0,03-0,001). Resistance to IM developed in 30 patients. In 7 of them mutation of Bcr/Abl kinase domain was identified, while additional cytogenetic abnormalities and hyper-expression of Bcr/Abl were the cause of resistance in 8 and 2 patients, respectively. The actual cause of resistance was not identified in remaining 10 patients. Initial risk assessment and careful monitoring of patients for the response and for the signs of resistance are crucial for both IF and IM treatment management.
P030 Chronic myelogenous leukemia Casablanca experience retrospective study about 431 cases M. Fk, S. Cherkaoui, A. Quessar, S. Benchekroun. Department of Medicine and Oncology, Pediatric Hospital 20 Aout, Casablanca, Morocco Aim: Chronic myelogenous leukemia (CML) is a myeloproliferative disease associated with a characteristic chromosomal translocation. Imatinib mesylate (GlivecR) have radically changed the management of CML with cytogenetic remission in 85% of cases.The aim of this retrospective study is to evaluate epidemiological and clinical features, and the treatment results of CML in our department Patients and methods: We reviewed the database of patients diagnosed with CML from January 1995 to December 2005. CML is diagnosed on the basis on the complete blood count (CBC) and bone marrow morphology. Philadelphia chromosome is detected by conventional cytogenetics but not done for all patients Results: A total of 431 patients were included with sex-ratio F/H at 1.03. The mean age was 43.9 years. The mean delay to diagnosis was 9.6 months (1 to 96 months). The commonest sign at presentation was a pressure under the left ribs (81%). In 1.5% of cases, patients were asymptomatic, presenting incidentally with an elevated white blood cell count on a routine laboratory test. The physical examination revealed a splenomegaly in 94.5% of cases. A CBC showed an increased number of white blood cells ≥ 100000/mm3 80.5% of cases. At the time of diagnosis, 83% of patients were in the chronic phase, 4% in accelerated phase and 13% in blast crisis. Karyotype was done for 158 patients (36.5and showed the translocation t(9,22) in 94.5% of cases. It was normal in 6 patients. All patients were treated with Hydroxyuree. Eight patients received interferon and 31 received Glivec witch was associated with cytogenetic response in 68% of cases. 174 patients were lost to follow up (40%), 97 patients died (22.5%) and 160 patients (37.5%) are still followed. Overall 8-year survival rate were at 30%. Conclusion: Great effort are ongoing in managing CML at our department, more patients received glivec bicause of health insurance generalisation and GIPAP program.
P031 Imatinib and aging: preliminary evaluation of efficacy and toxicity of two CML groups E. Tóthová, A. Kafková, M. Surová, E. Švorcová. Department of Hematology and Oncohematology, Medical Faculty Hospital and UPJS, Kosice, Slovak Republic Background: The age is included and acts as poor prognostic factor in the staging systems most employed (Sokal and Euro). Older patients have been generally excluded from most of the trials employing interferon, due to its toxic effects. Only few studies investigated the effect of imatinib in older chronic myeloid leukemia patients CML.
Poster Sessions
for careful monitoring of response to treatment with tyrosine kinase inhibitors in order to ensure that an individual patient receives the proper treatment and to decide if and when a therapy should be changed.
P029 Treatment of chronic myeloid leukemia with interferon and imatinib: results from the northern Moravia E. Faber, J. Zapletalová, I. Skoumalová, Š. Rožmanová, M. Holzerová, P. Rohoˇn, J. Veselovská, R. Solná, I. Marešová, N. Klusová, V. Divoký, M. Jarošová, K. Indrák. Department of Hemato-Oncology, University Hospital Olomouc, Olomouc, Czech Republic We report the results of CML treatment with interferon (IF) and imatinib (IM) in the Northern Moravia region. 38 (36%) of 107 patients (aged 19-71; median 49) treated with IF have achieved major or better cytogenetic response (CR). OS of patients treated with IF (median 99 months) was significantly influenced by Sokal score and achievement of the significant CR (p= 0,0031 and 0,0063). However, only 9 (8%) patients are continuing in IF therapy at present. Nearly half of the patients have stopped the treatment due to the primary resistance. Secondary resistance and intolerance were the cause in 27% and 13% of patients, respectively. On the other hand, 6 patients have stopped IF therapy after achievement of molecular response that has been continuing from 9 to 71 months. Treatment with IM was evaluated in 102 patients aged 17 to 78 years (median 52). 86 patients have started the therapy in chronic phase, 14 in acceleration and 2 in blastic phase. Interval from diagnosis to initiation of IM treatment ranged from 1 to 135 months (me 9). 28 patients were treated with IM early after diagnosis, 4 were pretreated with oral chemotherapy only and 70 patients with IF. IM was indicated due to intolerance of IF in 14 cases and because of hematologic or cytogenetic resistance to IF in 20 and 36 patients, respectively. Median duration of therapy was 34,3 months with range 0,36-73,7 months. Median follow-up of patients since diagnosis was 46,5 months with range from 7 to 207 months. 96 patients were evaluated for CR and molecular response. Complete CR was achieved in 73 (76%) patients; 24 (25%) of them achieved more than 3-log reduction in quantitative RTPCR assessment while 26 (27%) patients have achieved negativity in nested RT-PCR. Using Cox regression analysis phase of CML at initiation of IM, Sokal score and interval from diagnosis to the start of therapy were as factors associated with response to IM, OS and PFS of patients (p=0,03-0,001). Resistance to IM developed in 30 patients. In 7 of them mutation of Bcr/Abl kinase domain was identified, while additional cytogenetic abnormalities and hyper-expression of Bcr/Abl were the cause of resistance in 8 and 2 patients, respectively. The actual cause of resistance was not identified in remaining 10 patients. Initial risk assessment and careful monitoring of patients for the response and for the signs of resistance are crucial for both IF and IM treatment management.
P030 Chronic myelogenous leukemia Casablanca experience retrospective study about 431 cases M. Fk, S. Cherkaoui, A. Quessar, S. Benchekroun. Department of Medicine and Oncology, Pediatric Hospital 20 Aout, Casablanca, Morocco Aim: Chronic myelogenous leukemia (CML) is a myeloproliferative disease associated with a characteristic chromosomal translocation. Imatinib mesylate (GlivecR) have radically changed the management of CML with cytogenetic remission in 85% of cases.The aim of this retrospective study is to evaluate epidemiological and clinical features, and the treatment results of CML in our department Patients and methods: We reviewed the database of patients diagnosed with CML from January 1995 to December 2005. CML is diagnosed on the basis on the complete blood count (CBC) and bone marrow morphology. Philadelphia chromosome is detected by conventional cytogenetics but not done for all patients Results: A total of 431 patients were included with sex-ratio F/H at 1.03. The mean age was 43.9 years. The mean delay to diagnosis was 9.6 months (1 to 96 months). The commonest sign at presentation was a pressure under the left ribs (81%). In 1.5% of cases, patients were asymptomatic, presenting incidentally with an elevated white blood cell count on a routine laboratory test. The physical examination revealed a splenomegaly in 94.5% of cases. A CBC showed an increased number of white blood cells ≥ 100000/mm3 80.5% of cases. At the time of diagnosis, 83% of patients were in the chronic phase, 4% in accelerated phase and 13% in blast crisis. Karyotype was done for 158 patients (36.5and showed the translocation t(9,22) in 94.5% of cases. It was normal in 6 patients. All patients were treated with Hydroxyuree. Eight patients received interferon and 31 received Glivec witch was associated with cytogenetic response in 68% of cases. 174 patients were lost to follow up (40%), 97 patients died (22.5%) and 160 patients (37.5%) are still followed. Overall 8-year survival rate were at 30%. Conclusion: Great effort are ongoing in managing CML at our department, more patients received glivec bicause of health insurance generalisation and GIPAP program.
P031 Imatinib and aging: preliminary evaluation of efficacy and toxicity of two CML groups E. Tóthová, A. Kafková, M. Surová, E. Švorcová. Department of Hematology and Oncohematology, Medical Faculty Hospital and UPJS, Kosice, Slovak Republic Background: The age is included and acts as poor prognostic factor in the staging systems most employed (Sokal and Euro). Older patients have been generally excluded from most of the trials employing interferon, due to its toxic effects. Only few studies investigated the effect of imatinib in older chronic myeloid leukemia patients CML.