Comparison of the Efficacy Among Nilotinib, Dasatinib, Flumatinib and Imatinib in Newly Diagnosed Chronic-Phase Chronic Myeloid Leukemia Patients: A Real-World Multi-Center Retrospective Study

Xiaoshuai Zhang; Na Xu; Yunfan Yang; Hai Lin; Bingcheng Liu; Xin Du; Xiaoli Liu; Rong Liang; Chunyan Chen; Jian Huang; Huanling Zhu; Ling Pan; Xiaodong Wang; Guohui Li; Zhuogang Liu; Yanqing Zhang; Zhenfang Liu; Jianda Hu; Chunshui Liu; Fei Li; Wei Yang; Li Meng; Yanqiu Han; Li'e Lin; Zhenyu Zhao; Chuanqing Tu; Caifeng Zheng; Yanliang Bai; Zeping Zhou; Suning Chen; Huiying Qiu; Lijie Yang; Xiuli Sun; Hui Sun; Li Zhou; Zelin Liu; Danyu Wang; Jianxin Guo; Liping Pang; Qingshu Zeng; Xiaohui Suo; Weihua Zhang; Yuanjun Zheng; Yanli Zhang; Weiming Li; Qian Jiang

doi:10.1016/j.clml.2024.02.008

Comparison of the Efficacy Among Nilotinib, Dasatinib, Flumatinib and Imatinib in Newly Diagnosed Chronic-Phase Chronic Myeloid Leukemia Patients: A Real-World Multi-Center Retrospective Study

Clin Lymphoma Myeloma Leuk. 2024 Feb 15:S2152-2650(24)00067-3. doi: 10.1016/j.clml.2024.02.008. Online ahead of print.

Authors

Xiaoshuai Zhang¹, Na Xu², Yunfan Yang³, Hai Lin⁴, Bingcheng Liu⁵, Xin Du⁶, Xiaoli Liu², Rong Liang⁷, Chunyan Chen⁸, Jian Huang⁹, Huanling Zhu³, Ling Pan³, Xiaodong Wang¹⁰, Guohui Li¹¹, Zhuogang Liu¹², Yanqing Zhang¹³, Zhenfang Liu¹⁴, Jianda Hu¹⁵, Chunshui Liu⁴, Fei Li¹⁶, Wei Yang¹², Li Meng¹⁷, Yanqiu Han¹⁸, Li'e Lin¹⁹, Zhenyu Zhao¹⁹, Chuanqing Tu²⁰, Caifeng Zheng²⁰, Yanliang Bai²¹, Zeping Zhou²², Suning Chen²³, Huiying Qiu²³, Lijie Yang¹¹, Xiuli Sun²⁴, Hui Sun²⁵, Li Zhou²⁶, Zelin Liu²⁷, Danyu Wang²⁷, Jianxin Guo²⁸, Liping Pang²⁹, Qingshu Zeng³⁰, Xiaohui Suo³¹, Weihua Zhang³², Yuanjun Zheng³², Yanli Zhang³³, Weiming Li³⁴, Qian Jiang³⁵

Affiliations

¹ Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.
² Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
³ Department of Hematology, Institute of Hematology, West China Hospital, Sichuan University, Sichuan, China.
⁴ Department of Hematology, The First Hospital of Jilin University, Jilin, China.
⁵ National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjing, China.
⁶ Department of Hematology, The Second People's Hospital of Shenzhen, The First Affiliated Hospital of Shenzhen University, Shenzhen, China.
⁷ Department of Hematology, Xijing Hospital, Airforce Military Medical University, Xi'an, China.
⁸ Department of Hematology, Qilu Hospital of Shandong University, Jinan, China.
⁹ Department of Hematology, The First Affiliated Hospital of Zhejiang University, College of Medicine, Zhejiang University. Department of Hematology, The Fourth Affiliated Hospital of Zhejiang University, College of Medicine, Zhejiang University. Zhejiang Provincial Clinical Research Center for Haematological Disorders, Zhejiang, China.
¹⁰ Department of Hematology, Sichuan Academy of Medical Sciences Sichuan Provincial People's Hospital, Sichuan, China.
¹¹ Department of Hematology, Xi'an international medical center hospital, Xi'an, China.
¹² Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, China.
¹³ Department of Hematology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
¹⁴ Department of Hematology, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China.
¹⁵ Department of Hematology, Fujian Medical University Union Hospital, Fujian, China.
¹⁶ Center of Hematology, The First Affiliated Hospital of Nanchang University, Nanchang, China.
¹⁷ Department of Hematology, Tongji Hospital of Tongji Medical College, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.
¹⁸ Department of Hematology, The Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China.
¹⁹ Department of Hematology, Hainan General Hospital, Hainan, China.
²⁰ Department of Hematology, Shenzhen Baoan Hospital, Shenzhen University Second Affiliated Hospital, Shenzhen, China.
²¹ Department of Hematology, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Henan, China.
²² Department of Hematology, The Second Hospital Affiliated to Kunming Medical University, Kunming, China.
²³ National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Institute of Blood and Marrow Transplantation of Soochow University, Soochow, China.
²⁴ Department of Hematology, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
²⁵ Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
²⁶ Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
²⁷ Department of Hematology, Huazhong University of Science and Technology Union Shenzhen Hospital, Nanshan Hospital, Shenzhen, China.
²⁸ Department of Hematology, The Second Affiliated Hospital of Fujian Medical University, Fujian, China.
²⁹ Department of Hematology, Peking University Shenzhen Hospital, Shenzhen, China.
³⁰ Department of Hematology, The First Affiliated Hospital of Anhui Medical University, Anhui, China.
³¹ Department of Hematology, Handan Central Hospital, Handan, China.
³² Department of Hematology, First Hospital of Shanxi Medical University, Shanxi, China.
³³ Department of Hematology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Henan, China.. Electronic address: 13203729690@163.com.
³⁴ Department of Hematology, Union hospital, Tongji Medical college, Huazhong University of Science and Technology, Wuhan, China.. Electronic address: lee937@126.com.
³⁵ Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.; Peking University People's Hospital, Qingdao, China.. Electronic address: jiangqian@medmail.com.cn.

PMID: 38461040
DOI: 10.1016/j.clml.2024.02.008

Abstract

Background: There are limited data comprehensively comparing therapy responses and outcomes among nilotinib, dasatinib, flumatinib and imatinib for newly diagnosed chronic-phase chronic myeloid leukemia in a real-world setting.

Patients and methods: Data from patients with chronic-phase CML receiving initial a second-generation tyrosine-kinase inhibitor (2G-TKI, nilotinib, dasatinib or flumatinib) or imatinib therapy from 77 Chinese centers were retrospectively interrogated. Propensity-score matching (PSM) analyses were performed to to compare therapy responses and outcomes among these 4 TKIs.

Results: 2,496 patients receiving initial nilotinib (n = 512), dasatinib (n = 134), flumatinib (n = 411) or imatinib (n = 1,439) therapy were retrospectively interrogated in this study. PSM analyses indicated that patients receiving initial nilotinib, dasatinib or flumatinib therapy had comparable cytogenetic and molecular responses (p = .28-.91) and survival outcomes including failure-free survival (FFS, p = .28-.43), progression-free survival (PFS, p = .19-.93) and overall survival (OS) (p values = .76-.78) but had significantly higher cumulative incidences of cytogenetic and molecular responses (all p values < .001) and higher probabilities of FFS (p < .001-.01) than those receiving imatinib therapy, despite comparable PFS (p = .18-.89) and OS (p = .23-.30).

Conclusion: Nilotinib, dasatinib and flumatinib had comparable efficacy, and significantly higher therapy responses and higher FFS rates than imatinib in newly diagnosed CML patients. However, there were no significant differences in PFS and OS among these 4 TKIs. These real-world data may provide additional evidence for routine clinical assessments to identify more appropriate therapies.

Keywords: CML, Outcomes, Propensity-score matching (PSM), Second-generation tyrosine-kinase inhibitor (2G-TKI); Therapy responses.