Chronic myelogenous leukemia in nonlymphoid blastic phase - Analysis of the results of first salvage therapy with three different treatment approaches for 162 patients

BACKGROUND. The prognoses of patients with chronic myelogenous leukemia in blastic phase (CML-BP) are extremely poor. Treatment of patients with nonly mphoid CML-BP is associated with very lour response rates, a median surviva l of 2-3 months, and significant toxicities. The aim of this study was to e valuate the results of therapy in CML-BP with different treatments in relat ion to response rate, survival, and toxicity. METHODS, A total of 162 adults patients with a diagnosis of nonlymphoid CML -BP referred from 1986 to 1997 were included in this analysis. Only first s alvage therapy was considered for the purpose of this analysis. The blastic phase of CML was defined by the presence of 30% or more blasts in the bloo d or bone marrow, or extramedullary disease; Ninety patients were treated w ith intensive chemotherapy, 31 with decitabine, and 41 with other single ag ents. RESULTS, Thirty-six patients (22%) had an objective response. Response rate s were similar among patients treated with intensive chemotherapy (28%) or with decitabine (26%). In aggregate, other single agents showed objective r esponse rates of 7%. The median duration of remission for all patients was 29 weeks and tl-le median overall survival 22 weeks. Patients treated with decitabine showed a trend toward better survival, despite a higher percenta ge of older patients (P < 0.004). The median survival times were 29 weeks w ith decitabine, 21 weeks with intensive chemotherapy, and 22 weeks with oth er agents. When only older patients were considered survival was significan tly better with decitabine versus other treatments (P < 0.01),A multivariat e analysis of prognostic factors for survival confirmed the independent, si gnificant favorable effect of decitabine therapy (P = 0.047). In all groups complications of myelosuppression were the most significant side effects. Severe nonhematologic toxicities were not observed in patients treated with decitabine; they occurred in 20% and 17% of patients treated with intensiv e chemotherapy or other single agents, respectively CONCLUSIONS. Compared with intensive chemotherapy, decitabine showed favora ble results, with Similar objective response rates, a better nonhematologic toxicity profile, and a trend for better survival, particularly among olde r patients. Studies will now attempt to combine decitabine with other promi sing approaches, such as homoharringtonine, low dose cytarabine, and interf eron-alpha, in all CML phases. (C) 1999 American Cancer Society.