Irom Anil Singh1, Aditi Jain2, Pukhrambam Vedanti Devi3, Tombing Niangneihching4
BACKGROUND
Chronic myeloid leukemia (CML) accounts for 15 - 20 % of leukemia in adults
worldwide. At present, the three tyrosine kinase inhibitors (TKI) imatinib,
dasatinib, or nilotinib are accepted as the standard first-line treatment in chronic
phase (CP). Nilotinib is a second generation TKI having faster and deeper response
compared to imatinib. We wanted to see if the response achieved with nilotinib in
the first three months could be translated into long term benefits when imatinib
was given after 3 months.
METHODS
Newly diagnosed CML-CP patients were randomized into two arms. The patients
on the first arm were given imatinib and in the second arm nilotinib was given for
first 3 months. After three months nilotinib was switched over to imatinib. The
molecular response was assessed in both arms at 3 months and 6 months.
RESULTS
Twenty-six patients in each arm were analysed. The optimal molecular response
(QPCR <10 %) after 3 months was significantly higher in patients receiving
nilotinib than imatinib (96.1 % vs 65.38 %; P < 0.0048). The optimal response
after 6 months (QPCR < 1 %) was found to be more in the initial nilotinib arm
than the initial imatinib arm (76.9 % vs 65.3 %; P - value = 0.35).
CONCLUSIONS
Patients on nilotinib arm did well even after switching to imatinib. It gives us an
important platform for an economically backward country like India where the
therapy with more potent drug like nilotinib is given in the initial three months or
even six months.
