Abstract
In chronic myeloid leukemia (CML), imatinib may reverse bone marrow fibrosis (MF). Whether the unfavorable prognosis of MF is also reversed and whether imatinib guarantees against evolution of MF are unclear as yet. Fifty-nine patients with Ph+ CML treated with ⩾400 mg imatinib/day were examined for MF in 6- to 12-month intervals. Imatinib effectively reversed initial MF (P<0.0005). However, during a follow-up period of up to 4.8 years, small foci with abnormal fiber increase (FFI) emerged in 8 of 30 pretreated and 6 of 29 non-pretreated patients. Patients with FFI showed a significantly lower probability of achieving a complete cytogenetic or major molecular response (36 versus 81%; P<0.007). During the further follow up, 57% of patients with FFI but none of the other patients suffered from full-blown MF (P=0.00005). None of the patients with FFI or MF showed a Janus kinase-2 mutation (V617F). Evolutions of FFI and MF were independent significant predictors of imatinib failure (P=0.0031), accelerated phase and death of patients (P=0.0001; multivariate analyses). Imatinib effectively reverses initial MF in CML, but neither eliminates its unfavorable prognosis nor guarantees completely against new evolution of MF.
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Acknowledgements
We thank our clinical colleagues for their support in recruiting and validating data on cytogenetic±molecular response and course of disease, Dr R Hehlmann and Dr A Hochhaus for helpful comments and discussion of the data and M Engel, R Lohmann, M Markwart and S Schröter for their excellent technical assistance. This study was supported by a grant (Bu1103/2-1) from the Deutsche Forschungsgemeinschaft, Bonn, Germany
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Buesche, G., Ganser, A., Schlegelberger, B. et al. Marrow fibrosis and its relevance during imatinib treatment of chronic myeloid leukemia. Leukemia 21, 2420–2427 (2007). https://doi.org/10.1038/sj.leu.2404917
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DOI: https://doi.org/10.1038/sj.leu.2404917
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