Age influences initial dose and compliance to imatinib in chronic myeloid leukemia elderly patients but concomitant comorbidities appear to influence overall and event-free survival

Massimo Breccia, Luigiana Luciano, Roberto Latagliata, Fausto Castagnetti, Dario Ferrero, Francesco Cavazzini, Malgorzata Monica Trawinska, Mario Annunziata, Fabio Stagno, Mario Tiribelli, Gianni Binotto, Elena Crisà, Pellegrino Musto, Antonella Gozzini, Laura Cavalli, Enrico Montefusco, Alessandra Iurlo, Sabina Russo, Michele Cedrone, Antonella Russo RossiPatrizia Pregno, Mauro Endri, Antonio Spadea, Matteo Molica, Gianfranco Giglio, Francesca Celesti, Federica Sorà, Sergio Storti, Ada D'Addosio, Giovanna Rege Cambrin, Alessandro Isidori, Simona Sica, Elisabetta Abruzzese, Giorgina Speccha, Gianantonio Rosti, Giuliana Alimena

Research output: Contribution to journalArticlepeer-review

Abstract

We applied Charlson comorbidity index (CCI) stratification on a large cohort of chronic myeloid leukemia (CML) very elderly patients (>75 years) treated with imatinib, in order to observe the impact of concomitant diseases on both compliance and outcome. One hundred and eighty-one patients were recruited by 21 Italian centers. There were 95 males and 86 females, median age 78.6 years (range 75-93.6). According to Sokal score, 106 patients were classified as intermediate risk and 55 as high risk (not available in 20 patients). According to CCI stratification, 71 patients had score 0 and 110 a score ≥ 1. Imatinib standard dose was reduced at start of therapy (200-300. mg/day) in 68 patients independently from the evaluation of baseline comorbidities, but based only on physician judgement: 43.6% of these patients had score 0 compared to 34% of patients who had score ≥ 1. Significant differences were found in terms of subsequent dose reduction (39% of patients with score 0 compared to 53% of patients with score. ≥ 1) and in terms of drug discontinuation due to toxicity (35% of patients with score 0 vs 65% of patients with score ≥ 1). We did not find significant differences as regards occurrence of hematologic side effects, probably as a consequence of the initial dose reduction: 39% of patients with score 0 experienced grade 3/4 hematologic toxicity (most commonly anemia) compared to 42% of patients with score ≥ 1. Independently from the initial dose, comorbidities again did not have an impact on development of grade 3/4 non-hematologic side effects (most commonly skin rash, muscle cramps and fluid retention): 62% of patients with score 0 compared to 52.5% of patients with score ≥ 1. Notwithstanding the reduced dose and the weight of comorbidities we did not find significant differences but only a trend in terms of efficacy: 66% of patients with score 0 achieved a CCyR compared to 54% of patients with score ≥ 1. Comorbidities appeared to have an impact on median OS (40.8 months for patients with score 0 vs 20.16 months for patients with score ≥. 1) on EFS and on non-CML death rate. Our results suggest that treatment of very elderly CML patients might be influenced by personal physician perception: evaluation at baseline of comorbidities according to CCI should improve initial decision-making in this subset of patients.

Original languageEnglish
Pages (from-to)1173-1176
Number of pages4
JournalLeukemia Research
Volume38
Issue number10
DOIs
Publication statusPublished - Oct 1 2014

Keywords

  • Age
  • Chronic myeloid leukemia
  • Comorbidities
  • Overall survival

ASJC Scopus subject areas

  • Cancer Research
  • Hematology
  • Oncology

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