Summary of 615 patients of chronic myeloid leukemia in Shanghai from 2001 to 2006
Journal of Experimental & Clinical Cancer Research
Summary of 615 patients of chronic myeloid leukemia in Shanghai from 2001 to 2006
Ai-Hua Wang 0
Yan-Yan Wang 0
Yu Yao 0
Zi-Zhen Xu 0
Li Zhou 0
Li Wang 0
Li Zhang 0
Yu Chen 0
Zhi-Xiang Shen 0
Jiong Hu 0
Jun-Min Li 0
0 Department of Hematology, Ruijin Hospital, Shanghai Institute of Hematology, Shanghai Jiao-Tong University School of Medicine , Shanghai 200025 , China
Background: To retrospectively review the incidence, treatment efficacy, we followed up newly diagnosed chronic myelogenous leukemia (CML) patients residing in Shanghai during 2001-2006. Methods: All eligible cases were reviewed with the data of efficacy responses as well as overall survival (OS) and progression-free survival (PFS) time. Results: A total of 615 cases entered the study. CML mainly afflicted those aged 40-60 years old and was slightly more frequent in males than females. More than 85% of the patients were in chronic phase (CP) when diagnosed. All patients were divided into four groups based on the main regimens - hydroxyurea, interferon alpha (IFN-a), imatinib, and hemopoietic stem cell transplantation (HSCT). With the median follow-up of 18 months, imatinib treatment induced 92.2% complete hematologic responses, and 64.3% complete cytogenetic responses among CML-CP patients. Overall the therapeutic efficacy in the imatinib group was higher than that in the hydroxyurea or IFN-a group. Meanwhile, in the imatinib group, all response rates of patients in CP were significantly greater than that in accelerated or blastic crisis phase. The patients treated with imatinib also showed the most promising results regarding OS and PFS. Patients receiving HSCT decreased markedly in number with the introduction of imatinib. Conclusions: The number of new patients arising in Shanghai increased from 2001 to 2006. There were still patients receiving hydroxyurea and IFN-a. As the first-line regime for CML, imatinib was less administered in Shanghai before, but has received considerable development and great responses since 2003.
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Introduction
Chronic myeloid leukemia (CML) is a clonal
myeloproliferative disorder associated with chromosomal
translocation between chromosomes 9 and 22, which forms a
fusion gene of BCR-ABL encoding BCR-ABL fusion
protein. The excessive tyrosine kinase activity of this fusion
protein activates multiple signal transduction pathways,
which leads to malignant transformation [1,2].
Previous therapies for CML consisted of hemopoietic
stem cells transplantation (HSCT), interferon alpha
(IFN-a)-based treatment, and simple cell reduction
treatment with hydroxyurea (HU). Diagnostic and
therapeutic strategies for CML have progressed rapidly since
the first clinical trial of targeted tyrosine kinase inhibitor
imatinib mesylate (STI571, Glivec or Gleevec; Novartis
Pharma) was conducted in CML patients in 1998.
Currently, imatinib is considered as the first line treatment
regimen for CML [3]. Recently, two additional novel
kinase inhibitors, dasatinib (BMS354825; Sprycel;
Bristol-Myers Squibb) [4] and nilotinib (AMN107, nilotinib;
Novartis Pharma) [5], have become available as
treatment options for patients who have developed resistance
or those who have shown intolerance to imatinib.
We retrospectively reviewed 615 primary CML
patients administered in Shanghai from 2001 to 2006 in
order to evaluate diagnostic and treatment selection
criteria and treatment outcomes for CML.
Materials and methods
This was a retrospective review of local patients initially
diagnosed with any stage of CML during the period
January 1, 2001 to December 31, 2006. All patients whose
records were reviewed were registered with the Shanghai
Municipal Center for Disease Control, and validated by
one of the 21 hospitals in Shanghai participating in the
study. The diagnosis was confirmed by bone marrow
biopsy, chromosomal and fusion gene examination.
Medical records for all patients were reviewed
retrospectively with the follow-up ending on December 31st,
2007. Demographic data, symptoms, diagnosis,
treatment, and prognosis data were collected from clinic
data, written correspondence, and personal interviews.
Hematological response was defined as complete
hematological response (CHR) consisting of white blood
cell count <10 109/L, platelet count <450 109/L,
with no immature granulocytes visible in peripheral
blood, peripheral blood basophilic granulocyte <5%, and
no extramedullary infiltration. Cytogenetic response was
determined by the percentage of cells in metaphase that
were positive for the Ph chromosome in bone marrow.
Cytogenetic responses, based on analysis of 20 cells in
metaphase, were categorized as complete (CCyR, no
cells positive for the Ph chromosome) or partial (1 to 35
percent of cells positive for the Ph chromosome). Major
cytogenetic response (MCyR) was defined as the
combined rate of PCyR + CCyR.
Overall survival time (OS) was calculated from the
date of diagnosis to the date of (...truncated)