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4046 Prospective Metabolic and Cardiovascular Assessment in Chronic Phase Chronic Myeloid Leukemia Patients Treated with Nilotinib 300 Mg Bid Frontline in the Gimema 0811 TrialClinically Relevant Abstract

Chronic Myeloid Leukemia: Therapy
Program: Oral and Poster Abstracts
Session: 632. Chronic Myeloid Leukemia: Therapy: Poster III
Monday, December 7, 2015, 6:00 PM-8:00 PM
Hall A, Level 2 (Orange County Convention Center)

Massimo Breccia, MD1*, Fausto Castagnetti, MD/PhD2, Gabriele Gugliotta, MD/PhD2*, Bruno Martino, MD3*, Giuseppe Rossi, MD4, Angelo Michele Carella5, Fabio Stagno, MD/PhD6, Diamante Turri, MD7*, Paolo Avanzini, MD8*, Elena Trabacchi9*, Ivana Pierri, MD10*, Mario Tiribelli, MD11*, Alessandro Isidori, M.D. PhD12, Marzia Salvucci13*, Silvana Capalbo14, Anna Merli15*, Luciano Levato, MD16*, Gianni Binotto17*, Elena Maino18*, Serena Rupoli, MD19*, Fabrizio Pane, MD20, Giuseppe Saglio21, Michele Baccarani22, Giuliana Alimena23 and Gianantonio Rosti, MD2*

1Chair of Hematology, "Sapienza" University, Roma, Italy
2Institute of Hematology, S.Orsola-Malpighi University Hospital, Bologna, Italy
3Hamatology Dept., Ospedali Riuniti Bianchi Melacrino Morelli, Reggio Calabria, Italy
4Department of Hematology, Spedali Civili di Brescia, Brescia, Italy
5Division of Hematology 1, IRCCS A.O.U. San Martino IST, Genova, Genova, Italy
6Section of Hematology, A.O.U. Policlinico, Catania, Italy
7Section of Hematology, A.O. Cervello, Palermo, Italy
8Hematology, S.Maria Nuova Hospital, Reggio Emilia, Italy
9Guglielmo da Saliceto Hospital, Piacenza, Italy
10Hematology Clinic, IRCSS AOU S.Martino-IST, University of Genova, Genova, Italy
11Division of Hematology and BMT, Department of Experimental and Clinical Medical Sciences, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy
12Hematology and Stem Cell Transplant Center, AORMN Hospital, Pesaro, Italy
13S. Maria delle Croci Hospital, Ravenna, Italy
14Hematology, Ospedali Riuniti - Azienda Ospedaliero Universitaria, Foggia, Italy
15Hematology, Rimini, Italy
16Section of Hematology, A.O. Pugliese-Ciaccio, Catanzaro, Italy
17Department of Medicine, Hematology and Clinical Immunology, Padua School of Medicine, Padova, Italy
18Hematology Unit, Ospedale Dell'Angelo, Venezia-Mestre, Venezia-Mestre, Italy
19Haematology Clinic, Ospedali Riuniti di Ancona, Ancona, Italy
20Department of Biochemistry and Medical Biotechnologies, Federico II University, Napoli, Italy
21Dept. of Clinical and Biological Sciences, University of Turin, Orbassano-Torino, Italy
22Institute of Hematology, University of Bologna, Bologna, Italy
23Hematology, Sapienza University, Rome, Italy

Background. Nilotinib 300 mg BID was approved as frontline treatment in chronic phase chronic myeloid leukemia (CP-CML) patients and allowed to reach deep molecular responses in a shorter median time with reduction of progression rate. Nilotinib is associated to a specific safety profile, with metabolic side effect as the most common events and increased probability of cardiovascular disorders.

Aim. Aim of our study is to prospectively assess metabolic changes and cardiovascular safety during treatment with nilotinib, in a single arm multicentric Italian GIMEMA trial (0811), testing the drug as frontline treatment with the primary endpoint to obtain MR4 at 24 months. All metabolic changes were classified according to CTC grade. Lipidic changes were assessed according to American Association of Clinical endocrinologist criteria of 2012 and glucose abnormalities according to American diabetologist association (ADA).

Results. One hundred and thirty patients were enrolled in 33 different centers: median age 50.5 years (range 18-85), 64.6% male. Mean body mass index (BMI) was 25.3, with 40% of patients being overweight/obese according to WHO classification. At last contact, 100 patients were still in treatment, the majority with full dose (86%). According to ADA criteria 47%, 10%, 4.6% and 6% of patients experienced grade 1 (101-125 mg/dl), grade 2 (126-150 mg/dl), grade 3 (151-200 mg/dl) and grade 4 (>200 mg/dl), increased fasting glucose, respectively. As compared to baseline, a significant variation was observed after 1 year (p<0.001). Glycosylated haemoglobin increased in 47% as grade 1 (5.7-6.49%), 10% as grade 2 (6.5-6.99%), 3% as grade 3 (7-7.99) and 4.6% as grade 4 (>8), respectively according to ADA criteria. AACE criteria identified a significant reduction of triglycerides (p<0.001) and a significant increase of cholesterol both in LDL and HDL fractions (p<0.001). Five patients (3.8%) experienced a peripheral arterial disorders (2 patients with claudication, 2 stenosis and 1 patient with arterial optic ischaemic): one patient required temporary reduction and 1 patient permanent discontinuation. Four patients experienced a venous thrombosis. Six patients (4.6%) had an ischemic cardiac disease and 7 patients (5.3%) an arrhythmia: five patients, based on physician judgment discontinued the treatment.

Conclusions. Prospective monitoring of metabolic safety during frontline treatment with nilotinib 300 mg BID showed consistent and specific profile with increased glycaemia and cholesterol level, mostly of grade 1-2. Possible occurrences of cardiovascular side effects impose identification of patients at risk at baseline and a correct monitoring during follow-up.

Disclosures: Castagnetti: Novartis: Consultancy , Honoraria ; BMS: Consultancy , Honoraria ; Pfizer: Consultancy , Honoraria ; ARIAD: Consultancy , Honoraria . Gugliotta: BMS: Honoraria ; Novartis: Honoraria . Tiribelli: Novartis Farma: Consultancy , Speakers Bureau ; Bristol Myers Squibb: Consultancy , Speakers Bureau ; Ariad Pharmaceuticals: Consultancy , Speakers Bureau . Saglio: Pfizer: Consultancy , Honoraria ; ARIAD: Consultancy , Honoraria ; Bristol-Myers Squibb: Consultancy , Honoraria ; Novartis Pharmaceutical Corporation: Consultancy , Honoraria . Baccarani: PFIZER: Honoraria , Membership on an entity’s Board of Directors or advisory committees , Speakers Bureau ; NOVARTIS: Honoraria , Membership on an entity’s Board of Directors or advisory committees , Speakers Bureau ; Bristol-Myers Squibb: Honoraria , Membership on an entity’s Board of Directors or advisory committees , Speakers Bureau ; ARIAD Pharmaceuticals, Inc.: Honoraria , Membership on an entity’s Board of Directors or advisory committees , Speakers Bureau . Rosti: Novartis: Honoraria , Research Funding , Speakers Bureau ; Bristol Myers Squibb: Honoraria , Research Funding , Speakers Bureau .

*signifies non-member of ASH