First-line second generation tyrosine kinase inhibitors in patients with newly diagnosed accelerated phase chronic myeloid leukemia.

Accelerated phase (AP) CML at onset and have poorer prognosis than CP-CML. We hypothesize that off-license use of second generation TKI (TKI2) as front-line therapy might counterbalance this poor prognosis, with limited toxicity. In "real-life" conditions, newly diagnosed patients meeting the ELN cytological criteria for AP-CML or harboring ACA and treated with first-line TKI2 were included in this retrospective multicenter observational study. We enrolled 69 patients [69.5 % male, median age 49.5 years, median follow-up 43.5 months], segregated into hematologic AP [HEM-AP (n = 32)] and cytogenetically defined AP [ACA-AP (n = 37)]. Hematologic parameters were worse in HEM-AP [spleen size (p = 0.014), PB basophils (p < .001), PB blasts (p < .001), PB blasts+promyelocytes (p < .001), low hemoglobin levels (p < .001)]. Dasatinib was initiated in 56 % patients in HEM-AP and in 27 % in ACA-AP, nilotinib in 44 % and 73 % respectively. Response and survival do not differ, regardless of the TKI2: 81 % vs 84.3 % patients achieved CHR, 88 % vs 84 % CCyR, 73 % vs 75 % MMR respectively. The estimated 5-year PFS 91.5 % (95%CI: 84.51-99.06 %) and 5-year OS 96.84 % (95%CI: 92.61-100 %). Only BM blasts (p < 0.001) and BM blasts+promyelocytes (p < 0.001) at diagnosis negatively influenced OS. TKI2 as front-line therapy in newly diagnosed AP-CML induce excellent responses and survival, and counterbalance the negative impact of advanced disease phase.
Competing Interests: Declaration of Competing Interest Marie Balsat: Speaker for Novartis, Pfizer, Jazz pharmaceuticals, Amgen, Incyte Biosciences. Vincent Alcazer has nothing to disclose. Gabriel Etienne speaker for consultant for Novartis, BMS, Pfizer and Incyte Pharma and has given some lectures for BMS, Incyte Pharma, Pfizer and Novartis. He has received research grants from Novartis and BMS. Françoise Huguet: Speaker’s bureau for Novartis, Incyte Biosciences, Pfizer. Board entity for Novartis, Incyte Biosciences, Pfizer. Marc Berger institutional research grants from Novartis, Pfizer and Incyte Biosciences. Board entity for Novartis. Emilie Cayssials speaker for Incyte Biosciences. Aude Charbonnier speaker for Incyte biosciences, Novartis and Pfizer, board entity for Incyte biosciences, Novartis and Pfizer. Martine Escoffre-Barbe has nothing to disclose. Hyacinthe Johnson-Ansah board entity for Novartis. Laurence Legros speaker for Novartis, Incyte Biosciences and Pfizer, research grant from Incyte Biosciences. Lydia Roy board entity for Pfizer, Novartis. Speaker for Pfizer, Novartis. BMS. Research fundings from Bristol Myers Squibb, Pfizer and Novartis. Alain Delmer has nothing to disclose regarding this study. Jean-Christophe Ianotto has nothing to disclose. Corentin Orvain speaker for Novartis and Incyte Biosciences. Fabrice Larosa has nothing to disclose. Mathieu Meunier has nothing to disclose. Shanti Amé has nothing to disclose. Annalisa Andreoli has nothing to disclose. Pascale Cony-Makhoul speaker for Pfizer, Novartis Pharma and Incyte, institutional grant from Pfizer. Stéphane Morisset has nothing to disclose. Isabelle Tigaud has nothing to disclose. François-Xavier Mahon consultant for Novartis, speaker for Novartis. Delphine Rea is a consultant for Novartis, and board entity for BMS, Pfizer and Incyte Biosciences. Franck Emmanuel Nicolini: Speaker’s bureau for Novartis, Incyte Biosciences. Board’s entity for Incyte Biosciences, Pfizer and Novartis. Research fundings from Novartis and Incyte Biosciences Europe. Consultant for Sun Pharma Ltd, Novartis.
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