Continuation Of Therapy

Once a patient starts therapy with imatinib, early endpoints are predictive of longer-term response and should be followed carefully. The initial report on patients in chronic phase treated with imatinib after IFN-a failure showed that patients who have no cytogenetic response after 3 months of therapy have only a 12% probability of later achieving a complete cyto-genetic response with continuation of therapy. In contrast, patients who have achieved at least a minor cytogenetic response after 3-12 months of therapy have a 35-50% probability of later achieving a complete response.45 A similar analysis of patients with previously untreated chronic-phase CML derived from the IRIS population has recently been presented.46 Patients with no or minor cytogenetic response after 3 months of therapy have a 50% probability of achieving a complete cytogenetic response at 2 years. However, patients with no cytogenetic response after 6 months of therapy have only approximately a 10% probability of achieving a complete cytogenetic response at 2 years, compared with 50% for those with at least a minor response. After 12 months of therapy, only those patients who have achieved a partial cytogenetic response have a reasonable probability of achieving a complete response with continuation of therapy.46 These observations have been incorporated into the treatment algorithm proposed in Figure 18.1.

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