Choice of Frontline Tyrosine-Kinase Inhibitor and Early Events in Very Elderly Patients With Chronic Myeloid Leukemia in Chronic Phase: A “Campus CML” Study
C. Bucelli, I. Capodanno, M. C. Miggiano, F. Cavazzini, S. Leonetti Crescenzi, S. Russo, I. Carmosino, M. Annunziata, F. Sorà, M. Bonifacio, L. Luciano, G. Caocci, G. Loglisci, C. Elena, F. Lunghi, R. Mullai, I. Attolico, G. Binotto, E. Crisà, P. Sportoletti, A. Di Veroli, A. R. Scortechini, A. P. Leporace, A. Maggi, M. Crugnola, F. Stagno, R. Sancetta, P. Murgano, D. Rapezzi, D. Luzi, D. I. Vincelli, S. Galimberti, M. Bocchia, C. Fava, A. Malato, E. Abruzzese, G. Saglio, G. Specchia, M. Breccia, A. Iurlo, M. Tiribelli, R. Latagliata
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引用次数: 0
Abstract
Objectives
The study aimed to evaluate the utilization of frontline TKI therapy in a large cohort of elderly CP-CML patients.
Methods
A retrospective analysis was conducted on 332 CP-CML patients aged 75 years or older among 1929 diagnosed from January 2012 to December 2019 followed at 36 participating Hematology Centers involved in the “Campus CML” project.
Results
Among the patients analyzed, 85.8% received imatinib (IM) while 14.2% received second-generation TKIs (2G-TKI), 59.5% dasatinib, and 40.5% nilotinib. Most patients initiated IM at standard dose (67.3%) while 32.7% at reduced dose. A similar trend was observed with 2G-TKIs. The cumulative incidence of permanent TKI discontinuation at 12 months was 28.4%, primarily due to primary resistance (10.1%) and extra-hematologic toxicity (9.5%), with no significant difference between IM and 2G-TKI groups. Following the introduction of generic IM in Italy in 2018, IM usage increased significantly compared with 2G-TKIs.
Conclusions
IM was in our Centers the preferred frontline therapy for older CP-CML patients, with increasing utilization after the introduction of generic formulations. However, 2G-TKIs are still used in a substantial proportion of patients, suggesting individualized physician assessments regarding patient suitability and expectations. Further investigation is needed to assess efficacy and safety of reduced TKI doses in this patient population.
期刊介绍:
European Journal of Haematology is an international journal for communication of basic and clinical research in haematology. The journal welcomes manuscripts on molecular, cellular and clinical research on diseases of the blood, vascular and lymphatic tissue, and on basic molecular and cellular research related to normal development and function of the blood, vascular and lymphatic tissue. The journal also welcomes reviews on clinical haematology and basic research, case reports, and clinical pictures.