Cml Treated With Interferon

As interferon became the treatment of choice, the validity of the Sokal system came into question. To address the question of prognostic factors in patients treated with interferon, Hasford et al. analyzed data on 1303 patients aged 10-85 years and treated with interferon.15 This analysis identified age, spleen size, percentages of circulating blasts, basophils, and eosinophils, as well as platelet counts as significant prognostic factors. The resulting "Hasford" score was then validated on 322 different patients. This scoring system categorizes patients treated with interferon into low, intermediate, and high risk for survival, and does so more effectively than the Sokal score.16

Many, if not most, patients initially treated with interferon are now taking imatinib. Whether the Sokal and/or Hasford scoring systems are appropriate for prognostic determination in patients treated with ima-tinib is uncertain. In fact, in a study of 351 patients treated with imatinib after failure of interferon, age did not appear to be a significant prognostic indicator as it was in both the Sokal and Hasford scoring systems.17

Marin et al. studied 145 patients treated with ima-tinib after failure of interferon in chronic-phase CML.18 The analysis identified two independent predictors of progression-free survival after 3 months of therapy. Both a neutrophil count <1 X 109/L and ^65% Ph+ metaphases predicted poor survival. Patients who had neither risk factor had an 18-month survival of 100% compared to a survival of 33% if they had both. The investigators concluded that myelosup-pression from imatinib and failure to achieve cytoge-netic remission after 3 months predicts poor survival in patients treated with imatinib. Sneed et al. confirmed this observation in a study of 143 patients treated with imatinib after failure with interferon.19 In this study, drug-induced grade III myelosuppression reduced the CCR rate from 63-36% (P = 0.001).

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