Imatinib has transformed the prognosis and the management of chronic myeloid leukemia (CML) and, most probably, has changed the patterns of mortality rates. The present study explored this change at each disease severity level (Sokal-score) through a flexible statistical modeling of the effect of the year of diagnosis on the excess mortality rate (EMR). The study population consisted of 691 chronic phase patients diagnosed from 1990 to 2007 and reported to the Nord-Pas-de-Calais French CML registry. Imatinib was given to 93% of the patients diagnosed after 2000. Comparing the [1990;1994], [1995;1999] and [2000;2007] periods of diagnosis, the five-year relative survival improved from 64 to 66 and 88%. The year of diagnosis was associated with a significant reduction of the EMR but only in patients with intermediate to high Sokal scores. In high-risk patients diagnosed in the early nineties, a peak of excess mortality was observed during the second year of follow-up. That peak decreased progressively over the years of diagnosis until disappearing in patients diagnosed after 2000. In conclusion, this population study gives evidence for different effects according to Sokal scores of the use of imatinib on mortality in patients with chronic phase CML and shows that since 2000 the pattern of mortality of high-risk patients became similar to that of intermediate-risk ones.
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