Older patients with chronic myeloid leukemia face suboptimal molecular testing and tyrosine kinase inhibitor adherence.

Autor:	Shallis RM; Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT.; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT., Wang R; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT.; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT., Zeidan AM; Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT.; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT., Huntington SF; Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT.; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT., Neparidze N; Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT.; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT., Stempel JM; Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT.; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT., Mendez LM; Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT., Di M; Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT.; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT., Ma X; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT.; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT., Podoltsev NA; Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT.; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT.
Jazyk:	angličtina
Zdroj:	Blood advances [Blood Adv] 2023 Jul 11; Vol. 7 (13), pp. 3213-3224.
DOI:	10.1182/bloodadvances.2022009074
Abstrakt:	Tyrosine kinase inhibitor (TKI) use is critical in the care of patients with chronic myeloid leukemia (CML). Quantitative polymerase chain reaction (qPCR) testing for BCR-ABL1 every 3 months during the first year of TKI treatment is recommended to assure achievement of milestone response goals. Real-world evidence for the patterns of qPCR monitoring and TKI adherence in the older patient population is lacking. Using the Surveillance, Epidemiology, and End Results-Medicare database, we identified 1192 patients aged ≥66 years (median age, 74 years) with newly diagnosed CML who were followed up for ≥13 months from TKI initiation. In total, 965 patients (81.0%) had ≥1 test, with 425 (35.7%) and 540 (45.3%) of the patients tested during 1, 2, and ≥3 quarters (optimal monitoring) of the first year from TKI initiation, respectively. In multivariable analysis, diagnosis in later years and influenza vaccination before diagnosis, a proxy for health care access, were associated with optimal qPCR monitoring. Use of low-income subsidy and residing in census tracts with the lowest socioeconomic status were associated with less optimal monitoring. Patients with optimal monitoring were 60% more likely to be TKI adherent (odds ratio, 1.60; 95% CI, 1.11-2.31; P = .01) and had improved 5-year survival (hazard ratio, 0.66; 95% CI, 0.49-0.90; P < .01) than those without such monitoring. In this large, real-world study of CML management patterns, many older patients had suboptimal molecular monitoring, which was associated with decreased TKI adherence and worse survival. (© 2023 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.)
Databáze:	MEDLINE
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