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Interferon Used as First - Line CML Therapy

Interferon Used as First - Line CML Therapy

Dr. Bishop provides a round-up of presentations given at the
Hematologic Malignancies symposium, held in conjunction with the
Mid-Atlantic Oncology Program's 13th Annual Scientific Conference.

ATLANTA, Ga--More than 75 investigators from around the world
presented updates of ongoing clinical trials and initial data
from new trials involving hematologic malignancies. This report
includes results of studies from Italy, France, and the United
States on treatments for acute and chronic leukemias.

An Italian study suggests that alpha-interferon should be the
first-line treatment for chronic myelogenous leukemia (CML) patients
who are not candidates for allogeneic transplantation, Michele
Baccarani, MD, University Hospital of Udine, Italy, said in his
update of the Italian Cooperative Groups study of alpha-interferon
versus hydroxyurea (Hydrea) in the treatment of newly diagnosed
CML.

Dr. Baccarani emphasized that allogeneic stem cell transplantation
may be curative in up to 50% to 70% of CMLpatients; however, allogeneic
transplantation is limited to approximately 15% of patients, due
to age restrictions and donor availability.

In this study, patients who were ineligible to undergo allogeneic
stem cell transplantation were randomized to receive alpha-interferon
or hydroxyurea. The endpoints of this trial were hematologic response;
karyotypic response, ie, reduction in the number of cells expressing
the Philadelphia chromosome; and overall survival.

If patients randomized to receive alpha-interferon did not achieve
a hematologic response by 6 months, the drug was discontinued.
Likewise, among the remaining patients in this arm, the drug was
dropped if a karyotypic response was not achieved by 1 year.

Median survival for patients randomized to receive alpha-interferon
was 6 years, compared with 4 years for patients randomized to
receive hydroxyurea (P = .001). Patients who received alpha-interferon
appeared to have a slower progression from chronic phase to accelerated
phase and blast crisis. The survival advantage was only observed
in patients who achieved a karyotypic response, which occurred
in approximately 30% of the study patients.

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