Choice of Frontline Tyrosine-Kinase Inhibitor and Early Events in Very Elderly Patients With Chronic Myeloid Leukemia in Chronic Phase: A "Campus CML" Study.

Autor: Bucelli C; Hematology Division, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy., Capodanno I; Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy., Miggiano MC; Hematology Department, San Bortolo Hospital, Vicenza, Italy., Cavazzini F; Hematology Unit, University of Ferrara, Ferrara, Italy., Crescenzi SL; Hematology, San Giovanni Hospital, Rome, Italy., Russo S; Hematology, University of Messina, Messina, Italy., Carmosino I; Hematology, Department of Translational and Precision Medicine, Policlinico Umberto I-Sapienza University, Rome, Italy., Annunziata M; Hematology Unit, Cardarelli Hospital, Naples, Italy., Sorà F; Institute of Hematology, Policlinico Universitario A. Gemelli, 'Cattolica' University, Rome, Italy., Bonifacio M; Department of Medicine, Section of Hematology, University of Verona, Verona, Italy., Luciano L; Hematology, University Federico II, Naples, Italy., Caocci G; Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy., Loglisci G; Hematology, Vito Fazzi Hospital, Lecce, Italy., Elena C; Hematology, Policlinico San Matteo, University of Pavia, Pavia, Italy., Lunghi F; Division of Hematology and BMT, IRCCS San Raffaele Hospital, Milan, Italy., Mullai R; Division of Hematology and BMT, Department of Medical Area, University of Udine, Udine, Italy., Attolico I; Hematology and Transplantation Unit, University of Bari, Bari, Italy., Binotto G; Department of Medicine, Hematology and Clinical Immunology, University of Padua, Padua, Italy., Crisà E; Hematology, Ospedale Maggiore, Novara, Italy., Sportoletti P; Hematology, University of Perugia, Perugia, Italy., Di Veroli A; Hematology, Belcolle Hospital, Viterbo, Italy., Scortechini AR; Hematology Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy., Leporace AP; Hematology Unit Azienda Ospedaliero Universitaria Sant'Andrea, Roma, Italy., Maggi A; Hematology, San Giuseppe Moscati Hospital, Taranto, Italy., Crugnola M; Hematology, University of Parma, Parma, Italy., Stagno F; Hematology, Ferrarotto Hospital, Catania, Italy., Sancetta R; Hematology Unit, Dell'Angelo Hospital, Venezia-Mestre, Italy., Murgano P; Division of Hematology, Sant'Elia Hospital, Caltanissetta, Italy., Rapezzi D; Hematology, AO Santa Croce e Carle, Cuneo, Italy., Luzi D; Onco-Hematology Department, AO Santa Maria, Terni, Italy., Vincelli DI; Hematology, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy., Galimberti S; Department of Clinical and Experimental Medicine, Hematology, University of Pisa, Pisa, Italy., Bocchia M; Hematology, AOU Senese, Siena, Italy., Fava C; Hematology, Mauriziano Hospital, Torino, Italy., Malato A; Hematology, Cervello Hospital, Palermo, Italy., Abruzzese E; Hematology, Sant'Eugenio Hospital, Roma, Italy., Saglio G; Department of Clinical and Biological Sciences, University of Turin, Torino, Italy., Specchia G; School of Medicine, University of Bari, Bari, Italy., Breccia M; Hematology, Department of Translational and Precision Medicine, Policlinico Umberto I-Sapienza University, Rome, Italy., Iurlo A; Hematology Division, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy., Tiribelli M; Division of Hematology and BMT, Department of Medical Area, University of Udine, Udine, Italy., Latagliata R; Hematology, Belcolle Hospital, Viterbo, Italy.
Jazyk: angličtina
Zdroj: European journal of haematology [Eur J Haematol] 2024 Sep 12. Date of Electronic Publication: 2024 Sep 12.
DOI: 10.1111/ejh.14299
Abstrakt: 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.
(© 2024 The Author(s). European Journal of Haematology published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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