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Type: Journal article
Title: Imatinib compared with interferon and low-dose cytarabine for newly diagnosed chronic-phase chronic myeloid leukemia
Author: O'Brien, S.
Guilhot, F.
Larson, R.
Gathmann, I.
Baccarani, M.
Cervantes, F.
Cornelissen, J.
Fischer, T.
Hochhaus, A.
Hughes, T.
Lechner, K.
Nielsen, J.
Rousselot, P.
Reiffers, J.
Saglio, G.
Shepherd, J.
Simonsson, B.
Gratwohl, A.
Goldman, J.
Kantarjian, H.
et al.
Citation: New England Journal of Medicine, 2003; 348(11):994-1004
Publisher: Massachusetts Medical Soc
Issue Date: 2003
ISSN: 0028-4793
Statement of
O'Brien, Stephen G; Guilhot, François; Larson, Richard A; Gathmann, Insa; Baccarani, Michele; Cervantes, Francisco; Cornelissen, Jan J; Fischer, Thomas; Hochhaus, Andreas; Hughes, Timothy; Lechner, Klaus; Nielsen, Johan L; Rousselot, Philippe; Reiffers, Josy; Saglio, Giuseppe; Shepherd, John; Simonsson, Bengt; Gratwohl, Alois; Goldman, John M; Kantarjian, Hagop; Taylor, Kerry; Verhoef, Gregor; Bolton, Ann E; Capdeville, Renaud; Druker, Brian J
Abstract: Background: Imatinib, a selective inhibitor of the BCR-ABL tyrosine kinase, produces high response rates in patients with chronic-phase chronic myeloid leukemia (CML) who have had no response to interferon alfa. We compared the efficacy of imatinib with that of interferon alfa combined with low-dose cytarabine in newly diagnosed chronic-phase CML. Methods: We randomly assigned 1106 patients to receive imatinib (553 patients) or interferon alfa plus low-dose cytarabine (553 patients). Crossover to the alternative group was allowed if stringent criteria defining treatment failure or intolerance were met. Patients were evaluated for hematologic and cytogenetic responses, toxic effects, and rates of progression. Results: After a median follow-up of 19 months, the estimated rate of a major cytogenetic response (0 to 35 percent of cells in metaphase positive for the Philadelphia chromosome) at 18 months was 87.1 percent (95 percent confidence interval, 84.1 to 90.0) in the imatinib group and 34.7 percent (95 percent confidence interval, 29.3 to 40.0) in the group given interferon alfa plus cytarabine (P<0.001). The estimated rates of complete cytogenetic response were 76.2 percent (95 percent confidence interval, 72.5 to 79.9) and 14.5 percent (95 percent confidence interval, 10.5 to 18.5), respectively (P<0.001). At 18 months, the estimated rate of freedom from progression to accelerated-phase or blast-crisis CML was 96.7 percent in the imatinib group and 91.5 percent in the combination-therapy group (P<0.001). Imatinib was better tolerated than combination therapy. Conclusions: In terms of hematologic and cytogenetic responses, tolerability, and the likelihood of progression to accelerated-phase or blast-crisis CML, imatinib was superior to interferon alfa plus low-dose cytarabine as first-line therapy in newly diagnosed chronic-phase CML.
Keywords: IRIS Investigators; Humans; Leukemia, Myeloid, Chronic-Phase; Disease Progression; Piperazines; Pyrimidines; Interferon-alpha; Cytarabine; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Survival Rate; Prospective Studies; Adolescent; Adult; Aged; Middle Aged; Female; Male
Rights: © 2009 Massachusetts Medical Society.
RMID: 0020032224
DOI: 10.1056/NEJMoa022457
Appears in Collections:Medicine publications

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