Chronic myeloid leukemia - historical
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The purpose of this page is to provide references to regimens that are obsolete, outdated, or of historical interest only. As a general rule, this includes the inferior arm(s) of a randomized study, unless said regimens continue to be recommended by trustworthy sources such as the NCCN Guidelines. Is there a regimen missing from this list? See the main CML page for current regimens.
8 regimens on this page
8 variants on this page
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Chronic phase, first-line therapy
Busulfan monotherapy
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Galton 1953 | 1951 | Case series | ||
Tura et al. 1994 (MI400) | 1986-1988 | Phase 3 (C) | Interferon alfa-2a | Inferior OS |
Allan et al. 1995 | 1986-1994 | Phase 3 (C) | Interferon alfa-n1 | Inferior OS |
References
- Galton DA. Myleran in chronic myeloid leukaemia; results of treatment. Lancet. 1953 Jan 31;264(6753):208-13. link to original article contains dosing details in manuscript PubMed
- MI400: Tura S, Baccarani M, Zuffa E, Russo D, Fanin R, Zaccaria A, Fiacchini M; Italian Cooperative Study Group on Chronic Myeloid Leukemia. Interferon alfa-2a as compared with conventional chemotherapy for the treatment of chronic myeloid leukemia. N Engl J Med. 1994 Mar 24;330(12):820-5. link to original article PubMed
- Allan NC, Richards SM, Shepherd PC; UK Medical Research Council's Working Parties for Therapeutic Trials in Adult Leukaemia. UK Medical Research Council randomised, multicentre trial of interferon-alpha n1 for chronic myeloid leukaemia: improved survival irrespective of cytogenetic response. Lancet. 1995 Jun 3;345(8962):1392-7. link to original article contains dosing details in manuscript PubMed
Hydroxyurea monotherapy
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Tura et al. 1994 (MI400) | 1986-1988 | Phase 3 (C) | Interferon alfa-2a | Inferior OS |
Allan et al. 1995 | 1986-1994 | Phase 3 (C) | Interferon alfa-n1 | Inferior OS |
Hehlmann et al. 2003 (CML-Study II) | 1991-1994 | Phase 3 (C) | Hydroxyurea & Interferon alfa-2a | Inferior OS |
Chemotherapy
- Hydroxyurea (Hydrea) by the following weight-based criteria:
- 70 kg or less: 1500 mg/day PO
- More than 70 kg: 2000 mg/day PO
Continued indefinitely
Dose and schedule modifications
- Physicians were "free to adjust the dose" to achieve leukocyte counts between 5 to 20 x 109/L, "preferably in the lower part of this range"
References
- MI400: Tura S, Baccarani M, Zuffa E, Russo D, Fanin R, Zaccaria A, Fiacchini M; Italian Cooperative Study Group on Chronic Myeloid Leukemia. Interferon alfa-2a as compared with conventional chemotherapy for the treatment of chronic myeloid leukemia. N Engl J Med. 1994 Mar 24;330(12):820-5. link to original article PubMed
- Allan NC, Richards SM, Shepherd PC; UK Medical Research Council's Working Parties for Therapeutic Trials in Adult Leukaemia. UK Medical Research Council randomised, multicentre trial of interferon-alpha n1 for chronic myeloid leukaemia: improved survival irrespective of cytogenetic response. Lancet. 1995 Jun 3;345(8962):1392-7. link to original article contains dosing details in manuscript PubMed
- CML-Study III: Hehlmann R, Berger U, Pfirrmann M, Heimpel H, Hochhaus A, Hasford J, Kolb HJ, Lahaye T, Maywald O, Reiter A, Hossfeld DK, Huber C, Löffler H, Pralle H, Queisser W, Tobler A, Nerl C, Solenthaler M, Goebeler ME, Griesshammer M, Fischer T, Kremers S, Eimermacher H, Pfreundschuh M, Hirschmann WD, Lechner K, Wassmann B, Falge C, Kirchner HH, Gratwohl A. Drug treatment is superior to allografting as first-line therapy in chronic myeloid leukemia. Blood. 2007 Jun 1;109(11):4686-92. Epub 2007 Feb 22. link to original article does not contain dosing details PubMed NCT00002771
Hydroxyurea & Interferon alfa-2a
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Hehlmann et al. 2003 (CML-Study II) | 1991-1994 | Phase 3 (E-esc) | Hydroxyurea | Superior OS |
Hehlmann et al. 2007 (CML-Study III) | 1995-2001 | Phase 3 (E-de-esc) | Allo HSCT (no specific conditioning regimen) | Seems to have superior OS (primary endpoint) |
Gratwohl et al. 2015 (CML-Study IIIA) | 1997-2004 | Phase 3 (C) | Allo HSCT (no specific conditioning regimen) | Did not meet primary endpoint of OS |
Note: One of the few regimens compared in large RCTs against allogeneic HSCT.
References
- CML-Study II: Hehlmann R, Berger U, Pfirrmann M, Hochhaus A, Metzgeroth G, Maywald O, Hasford J, Reiter A, Hossfeld DK, Kolb HJ, Löffler H, Pralle H, Queisser W, Griesshammer M, Nerl C, Kuse R, Tobler A, Eimermacher H, Tichelli A, Aul C, Wilhelm M, Fischer JT, Perker M, Scheid C, Schenk M, Weiss J, Meier CR, Kremers S, Labedzki L, Schmeiser T, Lohrmann HP, Heimpel H; German CML Study Group. Randomized comparison of interferon alpha and hydroxyurea with hydroxyurea monotherapy in chronic myeloid leukemia (CML-study II): prolongation of survival by the combination of interferon alpha and hydroxyurea. Leukemia. 2003 Aug;17(8):1529-37. link to original article PubMed
- CML-Study III: Hehlmann R, Berger U, Pfirrmann M, Heimpel H, Hochhaus A, Hasford J, Kolb HJ, Lahaye T, Maywald O, Reiter A, Hossfeld DK, Huber C, Löffler H, Pralle H, Queisser W, Tobler A, Nerl C, Solenthaler M, Goebeler ME, Griesshammer M, Fischer T, Kremers S, Eimermacher H, Pfreundschuh M, Hirschmann WD, Lechner K, Wassmann B, Falge C, Kirchner HH, Gratwohl A. Drug treatment is superior to allografting as first-line therapy in chronic myeloid leukemia. Blood. 2007 Jun 1;109(11):4686-92. Epub 2007 Feb 22. link to original article does not contain dosing details PubMed NCT00002771
- CML-Study IIIA: Gratwohl A, Pfirrmann M, Zander A, Kröger N, Beelen D, Novotny J, Nerl C, Scheid C, Spiekermann K, Mayer J, Sayer HG, Falge C, Bunjes D, Döhner H, Ganser A, Schmidt-Wolf I, Schwerdtfeger R, Baurmann H, Kuse R, Schmitz N, Wehmeier A, Fischer JT, Ho AD, Wilhelm M, Goebeler ME, Lindemann HW, Bormann M, Hertenstein B, Schlimok G, Baerlocher GM, Aul C, Pfreundschuh M, Fabian M, Staib P, Edinger M, Schatz M, Fauser A, Arnold R, Kindler T, Wulf G, Rosselet A, Hellmann A, Schäfer E, Prümmer O, Schenk M, Hasford J, Heimpel H, Hossfeld DK, Kolb HJ, Büsche G, Haferlach C, Schnittger S, Müller MC, Reiter A, Berger U, Saußele S, Hochhaus A, Hehlmann R; SAKK; German CML Study Group. Long-term outcome of patients with newly diagnosed chronic myeloid leukemia: a randomized comparison of stem cell transplantation with drug treatment. Leukemia. 2016 Mar;30(3):562-9. Epub 2015 Oct 14. link to original article does not contain dosing details link to PMC article PubMed NCT00025402
Interferon alfa monotherapy
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Hehlmann et al. 1994 | 1983-1991 | Phase 3 (E-switch-ooc) | 1. Busulfan | Superior OS |
2. Hydrea | Did not meet primary endpoint of OS |
Note: This article does not specify the exact type of interferon alfa.
References
- Hehlmann R, Heimpel H, Hasford J, Kolb HJ, Pralle H, Hossfeld DK, Queisser W, Löffler H, Hochhaus A, Heinze B, Georgii A, Bartram CR, Griesshammer M, Bergmann L, Essers U, Falge C, Queisser U, Meyer P, Schmitz N, Eimermacher H, Walther F, Fett W, Kleeberg UR, Kabisch A, Nerl C, Zimmermann R, Meuret G, Tichelli A, Kanz L, Tigges FJ, Schmid L, Brockhaus W, Tobler A, Reiter A, Perker M, Emmerich B, Verpoort K, Zankovich R, Wussow PV, Prummer O, Thiele J, Buhr T, Carbonell F, Ansari H; German CML Study Group. Randomized comparison of interferon-alpha with busulfan and hydroxyurea in chronic myelogenous leukemia. Blood. 1994 Dec 15;84(12):4064-77. link to original article PubMed
Chronic phase, relapsed or refractory
Busulfan monotherapy
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Schilling & Meyer 1956 | NR | Non-randomized, fewer than 20 pts |
Unugur et al. 1957 | 1953-10 to 1956-01 | Non-randomized |
Chemotherapy
References
- Schilling RF, Meyer OO. Treatment of chronic granulocytic leukemia with 1, 4-dimethanesulfonyloxybutane (Myleran). N Engl J Med. 1956 May 24;254(21):986-9. link to original article PubMed
- Unugur A, Schulman E, Dameshek W. Treatment of chronic granulocytic leukemia with Myleran. N Engl J Med. 1957 Apr 18;256(16):727-34. link to original article PubMed
Interferon alfa-2b & DLI
DLI: Donor Lymphocyte Infusion
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Porter et al. 1994 | NR | Non-randomized, fewer than 20 pts |
Note: Patients had relapsed after allogeneic HSCT
Immunotherapy
References
- Porter DL, Roth MS, McGarigle C, Ferrara JL, Antin JH. Induction of graft-versus-host disease as immunotherapy for relapsed chronic myeloid leukemia. N Engl J Med. 1994 Jan 13;330(2):100-6. link to original article PubMed
Blast crisis
Hydroxyurea & Plicamycin
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Koller & Miller 1986 | NR | Pilot, fewer than 20 pts (RT) |
Chemotherapy
- Hydroxyurea (Hydrea) by the following laboratory-based criteria:
- WBC count more than 100 x 109/L: 4000 mg/day PO
- WBC count more than 75 x 109/L up to 100 x 109/L: 3000 mg/day PO
- WBC count more than 50 x 109/L up to 75 x 109/L: 2000 mg/day PO
- WBC count more than 30 x 109/L up to 50 x 109/L: 1500 mg/day PO
- WBC count more than 15 x 109/L up to 30 x 109/L: 1000 mg/day PO
- WBC count more than 7.5 x 109/L up to 15 x 109/L: 500 mg/day PO
- Plicamycin (Mithracin) 25 mcg/kg IV over 2 to 4 hours once per day on days 1, 3, 5, 7, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27
21-day course
References
- Koller CA, Miller DM. Preliminary observations on the therapy of the myeloid blast phase of chronic granulocytic leukemia with plicamycin and hydroxyurea. N Engl J Med. 1986 Dec 4;315(23):1433-8. link to original article contains dosing details in manuscript PubMed
Vincristine & Prednisone
Regimen
Study | Evidence |
---|---|
Marks et al. 1978 | Non-randomized |
Chemotherapy
- Vincristine (Oncovin) 2 mg/m2 IV once on day 1
Glucocorticoid therapy
- Prednisone (Sterapred) 60 mg/m2 PO once per day on days 1 to 7
7-day cycles
References
- Marks SM, Baltimore D, McCaffrey R. Terminal transferase as a predictor of initial responsiveness to vincristine and prednisone in blastic chronic myelogenous leukemia: a co-operative study. N Engl J Med. 1978 Apr 13;298(15):812-4. link to original article contains dosing details in manuscript PubMed