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CML Registry Joerg Hasford, MD Ludwig-Maximilians University Munich, Germany Speaker disclosed relations to Novartis
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European CML Registry M. BaccaraniItaly J. GuilhotFrance B. SimonssonSweden Joerg HasfordGermany IBEDepartment of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-Universität München Email:has@ibe.med.uni-muenchen.de
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Structure Objectives Clinical Data Epidemiological data Treatment survey Discussion Conclusions
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European CML Registry OBJECTIVES Clinical to develop and validate a comprehensive prognostic model which allows to optimise individual treatment choices in particular a prognostic model for treatment with imatinib to evaluate the impact of therapeutic drug monitoring, pharmacokinetics and patients’ compliance during the course of CML the sequelae of discontinuation of treatment after complete cytogenetic remission (CCR) the mechanisms and sequelae of imatinib failure
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European CML Registry OBJECTIVES Epidemiological to collect baseline and treatment data of representative samples of CML patients of all European countries to estimate the incidence of CML stratified for age, sex and region to evaluate the medical management of CML patients using the ELN recommendations (Blood 2006;108:1809-20)
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European CML Registry OBJECTIVES General to promote quality controlled molecular monitoring to foster continued medical education and spread of excellence to develop and keep updated a core data set for CML to provide a platform for the expedited evaluation of new treatments to promote European trials, meta-analyses and pooled data analyses
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Data provided by the cooperating study groups StudyType Treatment optionsn I - ICSG CML 21Phase IIimatinib 800 mg 82 I - ICSG CML 22Phase IIIimatinib 400 mg vs 800 mg 117 I - ICSG CML 23Phase IIimatinib 400mg365 German gr. CML IVPhase II4 arms imatinib treatment904 E - CML/PETHEMAPhase IIIimatinib treatment200 E - RELMCRegistryany imatinib therapy 318 Nordic CML001Phase IIIimatinib 400mg vs 800mg103 Nordic CML002Phase IIimatinib 400 mg vs 400mg+PEG-IFN50 ROM – RegistryRegistryany imatinib therapy 33 F - SpiritPhase III4 arms imatinib treatment370 PL - RegistryRegistryany imatinib therapy267 Total2809
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Inclusion criteria according to the CML Guidelines (Baccarani et al. Blood 2006) Patients with Philadelphia positive or BCR/ABL positive CML in early chronic phase* treated with a tyrosine kinase inhibitor (mainly imatinib) No age limitations 2062** of 2809 patients were included in the registry *Early chronic phase: patients in chronic phase and therapy begin with tyrosine kinase inhibitors within six months after diagnosis. **the number of accepted patients may decrease or increase slightly as baseline and follow up data are not available for all patients yet; therefore inclusion criteria are sometimes still missing.
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Study data expected for the European CML-Registry Cooperation with the Austrian study group, the OSHO study group, a Russian study group, and the CAMELIA / INFINITY are in progress.
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countrynMedian age in yearsn Sex (% female) France 37052 (18-81)37039 German group 56553 (16-83)56541 Italy 56352 (18-84)55940 Nordic group 13651 (17-82)9145 Poland 8648 (18-72)8942 Romania 738 (27-57)1040 E-PETHEMA 19744 (18-71)19745 E-RELMC 13146 (19-87)13135 European CML-Registry: Baseline characteristics
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European CML-Registry: Results Cytogenetic remission at month 12 completepartialminorminimalno response Registry* (n=802) 75.4 % 13.0 %3.6 % 3.9 % 4.1 % Female* (n=325) 76.6 %10.8 %3.1 %4.6 %4.9 % Male* (n=477) 74.6 %14.5 %3.9 %3.4 %3.6 % IRIS 69.0 %16.0 % All patients treated with imatinib 400 mg with or without co-medication, and data included if t > 2 months. * data was available of the German, Italian and Nordic study group
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CML-Incidence and treatment survey Population:Bavaria ~12.4 million inhabitants Data base:The Bavarian Association of SHI-Accredited Physicians (KVB) Coverage:83.5% of outpatient care in Bavaria (10.4 million) Time:2003 - 2005 CML case definition:ICD C92.1 Chronic myeloid leukemia and treatment with either imatinib, interferon alpha, hydroxyurea or busulfan, treatment > 1 year Joerg Hasford, Martin Tauscher
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Results - Incidence 2004201 new CML-patients→1.93 / 100,000 / year 2005187 new CML-patients→1.80 / 100,000 / year Age (median) Male:50.7 % 63 years Female:49.3 % 65 years Population (SHI):10,387,207
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Incidence of CML - International Data (WSP) BavariaUK 1 UK 2 Women1.060.47 0.67 Men1.360.721.00 All persons0.83 1 Mc Nally RJQ et al. Hematol Oncol 1997;15:173-189. 2 Phekoo KJ et al. Hematologica 2006;91:1400-1404. Incidence per 100’000
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Conclusions The European CML Registry has been successfully established. The cytogenetic remission rates 12 months after treatment initiation with imatinib 400 mg/d have been successfully reproduced. First epidemiological analyses indicate incidence estimates similar to the US, but comparatively high for Europe. Clinical trials select considerably younger and preferably male patients with a more benign prognosis. First results of the treatment survey indicate room for improvement.
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Thank you very much for your cooperation! Denmark / Finland / Israel / Norway / Sweden: Prof. B. Simonsson (Uppsala) France: Dr. J. Guilhot (Poitiers) Czech Republic / Germany / Switzerland: Prof. R. Hehlmann (Mannheim) Italy: Prof. M. Baccarani (Bologna) Poland: Prof. A. Hellmann (Gdansk) Romania: Prof. A. Colita (Bucharest) Spain: Prof. F. Cervantes (Barcelona) Spain: Prof. J.L. Steegmann (Madrid) The Bavarian Association of SHI-Accredited Physicians (KVB) M. Tauscher
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The European CML Registry Group in Munich D. Lindörfer M. Pfirrmann, Dipl.Stat., M.Sc., Dr. rer.biol.hum. J. Hasford, Prof. Dr.
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Joerg Hasford, MD Ludwig-Maximilians University Munich, Germany
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