High-dose imatinib for newly diagnosed chronic phase chronic myeloid leukemia patients—Systematic review and meta-analysis

✍ Scribed by Anat Gafter-Gvili; Avi Leader; Ronit Gurion; Liat Vidal; Ron Ram; Adi Shacham-Abulafia; Isaac Ben-Bassat; Michael Lishner; Ofer Shpilberg; Pia Raanani

• Publisher: John Wiley and Sons
• Year: 2011
• Tongue: English
• Weight: 319 KB
• Volume: 86
• Category: Article
• ISSN: 0361-8609
• DOI: 10.1002/ajh.22076

✦ Synopsis

Abstract

Imatinib at a dose of 400 mg daily is considered frontline treatment in chronic phase chronic myeloid leukemia (CP‐CML).

We conducted a systematic review and meta‐analysis of randomized controlled trials comparing frontline treatment with imatinib 400 mg daily versus higher doses (≥600 mg daily) in patients with CP‐CML.

The search yielded four trials, randomizing 1,673 patients. At 12 months, high dose compared with standard dose imatinib improved complete cytogenetic response (CCyR) (RR 1.17, 95% CI 1.08–1.26, four trials, I^2^ = 33%) as well as major molecular response (MMolR) (RR 1.26, 95% CI 1.12–1.42, four trials, I^2^ = 0%). There was no difference in all‐cause mortality or disease progression at the end of follow up. Adverse events requiring discontinuation were more common in the high‐dose arm (RR 1.98, 95% CI 1.20–3.26, three trials, I^2^ = 0%), as were Grade III/IV neutropenia and thrombocytopenia: RR 1.56, 95% CI 1.15–2.12 and RR 1.86, 95% CI 1.28–2.70, respectively.

There is currently insufficient evidence to support the routine use of higher doses of imatinib as frontline treatment for CP‐CML. Extended follow up is needed to evaluate if the superior CCyR and MMolR with higher doses of imatinib will translate to long‐term clinical benefit. Am. J. Hematol. 86:657–662, 2011. © 2011 Wiley‐Liss, Inc.