Monday, June 7, 2010

Optimal treatment for CML (Chronic Myeloid Leukemia)

What's the optimal treatment for CML (Chronic Myeloid Leukemia)?  In the New England Journal of Medicine (NEJM), there were a few interesting articles this week that caught my attention:
  • Dasatinib versus Imatinib in Newly Diagnosed Chronic-Phase Chronic Myeloid Leukemia
  • Nilotinib versus Imatinib for Newly Diagnosed Chronic Myeloid Leukemia
Both of these studies were comparing imatinib (Gleevec) to newer drugs (dasatinib or Sprycel and nilotinib or Tasigna). In both cases, the newer agent appeared to result in better clinical responses (see conclusions below). If this is now the case, where does imatinib fall into treatment regimens for CML?  Who's going to want to receive Gleevec for their CML?

Conclusions: Dasatinib, administered once daily, as compared with imatinib, administered once daily, induced significantly higher and faster rates of complete cytogenetic response and major molecular response. Since achieving complete cytogenetic response within 12 months has been associated with better long-term, progression-free survival, dasatinib may improve the long-term outcomes among patients with newly diagnosed chronic-phase CML.

Conclusions: Nilotinib at a dose of either 300 mg or 400 mg twice daily was superior to imatinib in patients with newly diagnosed chronic-phase Philadelphia chromosome–positive CML.

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