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

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 = 0.28 - 0.91) and survival outcomes including failure-free survival (FFS, p = 0.28 - 0.43), progression-free survival (PFS, p = 0.19 - 0.93) and overall survival (OS) (p values = 0.76 - 0.78) but had significantly higher cumulative incidences of cytogenetic and molecular responses (all p values < 0.001) and higher probabilities of FFS (p < 0.001 - 0.01) than those receiving imatinib therapy, despite comparable PFS (p = 0.18 - 0.89) and OS (p = 0.23 - 0.30). 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.