Assessment of the early reach ability of major molecular response (MMR) in chronic phase of CML Egyption patients on first(1st) and second(2nd) generation TKI(as regard 1st and 2nd line of treatment

Abstract

Abstract Background Nilotinib has been shown to be a more potent inhibitor of BCR-ABL than imatinib. We evaluated the efficacy and safety of nilotinib, as compared with imatinib, in patients with newly diagnosed Philadelphia chromosome–positive chronic myeloid leukemia (CML) in the chronic phase Aim of the work Comparsion between the early reach ability of major molecular response (MMR) in chronic phase of CML patients on first(1st) and second(2nd) generation TKI(as regard 1st and 2nd line of treatmen t Patients and methods major molecular response (MMR) was assessed by quantative PCRfor BCR –ABL in 100 paients with newly diagnosed CML d ivided to three groups, group 1 included 40 patients on first generation tKI(imitinib), group 2 included 40 patients shifted from 1st generation (imitinib) to 2nd generation (nilotinib) and groups 3 included 20 patients on 2nd generation (nilotinib) from the start. The patients were recruited from clinical hematology department at Ain shams university hospital over the period from1/2018 to1/2019 Results in CML patients, rate of MMRat 12 months of treatment on 2nd generation TKI (nilotinib) as 1st line was higher than other groups (p = 0.025*), rate of EMR was higher in patients on nilotinib 300 mg than on imitinib 400 mg(p = <0.001) in CMl patients started on imitinib 400mg with additional cyto genetics abnormalities had high numbers of failure of MMR(p = 0.001) in comparsion to patients on nilotinib either 1st line or shifted. in CMl patients started on nilotinib 300mg had rising of liver functions than patients on imitinib(p = 0.002 in CMl patients started on nilotinib 3oomg as 1st line had high numbers of ECG chnges than patients on imitinib4oomg(p = 0.005) in CMl patientswith high sockal score started on imitinib 400mg had high number s of failure of MMR in comparsion to patients on nilotinib 300 mg(p < 0.001) in CMl patients, rateof CCR at6 and 12month had higher in patients started on nilotinib 300mgthan imitinib 400mg (p = 0.020) Conclusion treatment with first-line nilotinib is a better clinical strategy than starting with imatinib followed by switching to nilotinib for inadequate responses