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Unexpected occurrence of second malignancies in patients treated with interferon followed by imatinib mesylate for chronic myelogenous leukemia

Leukemia volume 19, pages 1689–1692 (2005)Cite this article

TO THE EDITOR

Imatinib mesylate has been shown to selectively inhibit the tyrosine kinase domain of the oncogenic bcr-abl fusion protein in vitro and using animal models. Thereafter, impressive responses have been reported by several phases II and one phase III studies in patients with chronic myelogenous leukemia (CML) at all stages. Particularly, complete hematological responses and also early cytogenetic responses were observed for most patients with chronic phase disease.1 Considering these goals, as well as progression to advanced phase disease, superiority of imatinib was demonstrated in comparison to previous treatments (interferon alfa (IFNα) and combination of IFNα and cytarabine) and it has become the first-line therapy for the majority of patients with newly diagnosed chronic phase CML.2 A recent update of the randomized phase III IRIS trial confirmed the better results of imatinib, median follow-up being still short (42 months).3 Indeed, efficiency of the targeted therapy was observed at the molecular level, with a rate of bcr-abl transcript becoming very low, even undetectable for some patients. However, despite complete sustained molecular response, discontinuation of imatinib is currently not recommended, as relapse may occur.4 This address the important issue of imatinib long-term side effects, particularly for younger patients. Giving current available data, treatment with imatinib is generally well tolerated, the risk of severe adverse event being low.5 Side effects most commonly include mild to moderate edema, nausea and vomiting, diarrhea, muscle cramps, and cutaneous reactions. Hepatic transaminase level elevations and myelosuppression occur less frequently and resolve with interruption of imatinib therapy. However, with almost 5 years experience with imatinib there is still some concern about the long-term side effects. We recently encountered in our institution several patients with CML who were treated with imatinib and in whom second neoplasms developed. This observation prompted a search for the occurrence of second neoplasms in our cohort of 189 patients treated with imatinib.

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Authors and Affiliations

  1. Department of Oncology-Hematology and Cell Therapy, Clinical Research Centre, Poitiers, Cedex, France

    L Roy, J Guilhot, G Martineau, R Larchée & F Guilhot

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  1. L Roy
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  2. J Guilhot
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Correspondence to F Guilhot.

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Roy, L., Guilhot, J., Martineau, G. et al. Unexpected occurrence of second malignancies in patients treated with interferon followed by imatinib mesylate for chronic myelogenous leukemia. Leukemia 19, 1689–1692 (2005). https://doi.org/10.1038/sj.leu.2403874

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