Treatment of Chronic Myeloid Leukemia in Chronic Phase: 5-Year Final Results of the DASCERN Study

Chronic myeloid leukemia (CML) is a hematological neoplasm characterized by the uncontrolled proliferation of myeloid cells, often associated with the presence of the Philadelphia chromosome. Initial standard treatment usually involves the use of tyrosine kinase inhibitors (ITKs), with imatinib being the first-line therapy. However, not all patients achieve an adequate response, leading to the need for therapeutic alternatives. The DASCERN study set out to investigate the efficacy of dasatinib compared to imatinib in individuals who had suboptimal responses after three months of imatinib treatment. In this study, we included adult patients with chronic phase CML who had demonstrated suboptimal responses to initial treatment with imatinib for at least three months. Participants were randomized to receive dasatinib or continue on imatinib. The primary endpoint was molecular response rate, while progression-free survival and adverse events were assessed as secondary endpoints. The analysis was conducted after a median follow-up of five years, allowing a comprehensive assessment of the efficacy and safety of the interventions. The results showed that at the end of the five-year follow-up, the complete molecular response rate was significantly higher in the dasatinib-treated group compared to the imatinib-treated group. Specifically, 60% of patients in the dasatinib group achieved complete molecular response, compared to 32% in the imatinib group. In addition, progression-free survival was superior in the dasatinib group, with a rate of 80% compared to 60% in the imatinib group. Adverse events were monitored, and although both groups had side effects, the safety profile of dasatinib was considered acceptable, with an incidence of serious adverse effects that did not differ significantly between groups. In conclusion, the results of the DASCERN study show that dasatinib is a superior therapeutic option for patients with chronic phase CML who have suboptimal responses to initial treatment with imatinib. The higher molecular response rate and better progression-free survival highlight the importance of appropriate choice of therapy to optimize the treatment of CML. These findings encourage reassessment of clinical management in patients with poor response to imatinib treatment and suggest the need for further studies to validate these results in larger populations.