• DOI:10.1056/NEJMOA022457
• Corpus ID: 20464466

Imatinib compared with interferon and low-dose cytarabine for newly diagnosed chronic-phase chronic myeloid leukemia.

@article{OBrien2003ImatinibCW,
  title={Imatinib compared with interferon and low-dose cytarabine for newly diagnosed chronic-phase chronic myeloid leukemia.},
  author={Stephen G. O’Brien and François Guilhot and Richard A. Larson and Insa Gathmann and Michele Baccarani and Francisco Cervantes and Jan J Cornelissen and Thomas J. Fischer and Andreas Hochhaus and Timothy P. Hughes and Klaus Lechner and Johan Lanng Nielsen and Philippe Rousselot and Josy Reiffers and Giuseppe Saglio and John D. Shepherd and Bengt Simonsson and Alois Gratwohl and John M. Goldman and Hagop M. Kantarjian and Kerry E. Taylor and Gregor E. G. Verhoef and Ann E Bolton and Renaud Capdeville and Brian J. Druker},
  journal={The New England journal of medicine},
  year={2003},
  volume={348 11},
  pages={
          994-1004
        }
}

• S. O’Brien, F. Guilhot, +22 authors B. Druker
• Published 13 March 2003
• Medicine, Biology
• The New England journal of medicine

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.