Imatinib and polypharmacy in very old patients with chronic myeloid leukemia: Effects on response rate, toxicity and outcome

Alessandra Iurlo, Alessandro Nobili, Roberto Latagliata, Cristina Bucelli, Fausto Castagnetti, Massimo Breccia, Elisabetta Abruzzese, Daniele Cattaneo, Carmen Fava, Dario Ferrero, Antonella Gozzini, Massimiliano Bonifacio, Mario Tiribelli, Patrizia Pregno, Fabio Stagno, Paolo Vigneri, Mario Annunziata, Francesco Cavazzini, Gianni Binotto, Giovanna MansuetoSabina Russo, Franca Falzetti, Enrico Montefusco, Gabriele Gugliotta, Sergio Storti, Ada M. D'Addosio, Luigi Scaffidi, Laura Cortesi, Michele Cedrone, Antonella Russo Rossi, Paolo Avanzini, Endri Mauro, Antonio Spadea, Francesca Celesti, Gianfranco Giglio, Alessandro Isidori, Monica Crugnola, Elisabetta Calistri, Federica Sorà, Giovanna Rege-Cambrin, Simona Sica, Luigiana Luciano, Sara Galimberti, Ester M. Orlandi, Monica Bocchia, Mauro Tettamanti, Giuliana Alimena, Giuseppe Saglio, Gianantonio Rosti, Pier Mannuccio Mannucci, Agostino Cortelezzi

Research output: Contribution to journalArticle

Abstract

Background: About 40% of all patients with chronic myeloid leukemia are currently old or very old. They are effectively treated with imatinib, even though underrepresented in clinical studies. Furthermore, as it happens in the general population, they often receive multiple drugs for associated chronic illnesses. Aim of this study was to assess whether or not in imatinib-treated patients aged > 75 years the exposure to polypharmacy (5 drugs or more) had an impact on cytogenetic and molecular response rates, event-free and overall survival, as well as on hematological or extra-hematological toxicity. Methods: 296 patients at 35 Italian hematological institutions were evaluated. Results: Polypharmacy was reported in 107 patients (36.1%), and drugs more frequently used were antiplatelets, diuretics, proton pump inhibitors, ACE-inhibitors, beta-blockers, calcium channel blockers, angiotensin II receptors blockers, statins, oral hypoglycemic drugs and alpha blockers. Complete cytogenetic response was obtained in 174 patients (58.8%), 78 (26.4%) within 6 month, 63 (21.3%) between 7 and 12 months. Major molecular response was obtained in 153 patients (51.7%), 64 (21.6%) within the 12 month. One hundred and twenty-eight cases (43.2%) of hematological toxicity were recorded, together with 167 cases (56.4%) of extra-hematological toxicity. Comparing patients exposed to polypharmacy to those without, no difference was observed pertaining to the dosage of imatinib, cytogenetic and molecular responses and hematological and extra-hematological toxicity. Conclusion: Notwithstanding the several interactions reported in the literature between imatinib and some of the medications considered herewith, this fact does not seem to have a clinical impact on response rate and outcome.

Original languageEnglish
Pages (from-to)80083-80090
Number of pages8
JournalOncotarget
Volume7
Issue number48
DOIs
Publication statusPublished - 2016

Fingerprint

Polypharmacy
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Cytogenetics
Pharmaceutical Preparations
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Proton Pump Inhibitors
Angiotensin Receptor Antagonists
Calcium Channel Blockers
Imatinib Mesylate
Angiotensin-Converting Enzyme Inhibitors
Diuretics
Hypoglycemic Agents
Disease-Free Survival
Chronic Disease
Population

Keywords

  • Chronic myeloid leukemia
  • Comorbidities
  • Imatinib
  • Old patients
  • Polypharmacy

ASJC Scopus subject areas

  • Oncology

Cite this

Imatinib and polypharmacy in very old patients with chronic myeloid leukemia : Effects on response rate, toxicity and outcome. / Iurlo, Alessandra; Nobili, Alessandro; Latagliata, Roberto; Bucelli, Cristina; Castagnetti, Fausto; Breccia, Massimo; Abruzzese, Elisabetta; Cattaneo, Daniele; Fava, Carmen; Ferrero, Dario; Gozzini, Antonella; Bonifacio, Massimiliano; Tiribelli, Mario; Pregno, Patrizia; Stagno, Fabio; Vigneri, Paolo; Annunziata, Mario; Cavazzini, Francesco; Binotto, Gianni; Mansueto, Giovanna; Russo, Sabina; Falzetti, Franca; Montefusco, Enrico; Gugliotta, Gabriele; Storti, Sergio; D'Addosio, Ada M.; Scaffidi, Luigi; Cortesi, Laura; Cedrone, Michele; Rossi, Antonella Russo; Avanzini, Paolo; Mauro, Endri; Spadea, Antonio; Celesti, Francesca; Giglio, Gianfranco; Isidori, Alessandro; Crugnola, Monica; Calistri, Elisabetta; Sorà, Federica; Rege-Cambrin, Giovanna; Sica, Simona; Luciano, Luigiana; Galimberti, Sara; Orlandi, Ester M.; Bocchia, Monica; Tettamanti, Mauro; Alimena, Giuliana; Saglio, Giuseppe; Rosti, Gianantonio; Mannucci, Pier Mannuccio; Cortelezzi, Agostino.

In: Oncotarget, Vol. 7, No. 48, 2016, p. 80083-80090.

Research output: Contribution to journalArticle

Iurlo, A, Nobili, A, Latagliata, R, Bucelli, C, Castagnetti, F, Breccia, M, Abruzzese, E, Cattaneo, D, Fava, C, Ferrero, D, Gozzini, A, Bonifacio, M, Tiribelli, M, Pregno, P, Stagno, F, Vigneri, P, Annunziata, M, Cavazzini, F, Binotto, G, Mansueto, G, Russo, S, Falzetti, F, Montefusco, E, Gugliotta, G, Storti, S, D'Addosio, AM, Scaffidi, L, Cortesi, L, Cedrone, M, Rossi, AR, Avanzini, P, Mauro, E, Spadea, A, Celesti, F, Giglio, G, Isidori, A, Crugnola, M, Calistri, E, Sorà, F, Rege-Cambrin, G, Sica, S, Luciano, L, Galimberti, S, Orlandi, EM, Bocchia, M, Tettamanti, M, Alimena, G, Saglio, G, Rosti, G, Mannucci, PM & Cortelezzi, A 2016, 'Imatinib and polypharmacy in very old patients with chronic myeloid leukemia: Effects on response rate, toxicity and outcome', Oncotarget, vol. 7, no. 48, pp. 80083-80090. https://doi.org/10.18632/oncotarget.11657
Iurlo, Alessandra ; Nobili, Alessandro ; Latagliata, Roberto ; Bucelli, Cristina ; Castagnetti, Fausto ; Breccia, Massimo ; Abruzzese, Elisabetta ; Cattaneo, Daniele ; Fava, Carmen ; Ferrero, Dario ; Gozzini, Antonella ; Bonifacio, Massimiliano ; Tiribelli, Mario ; Pregno, Patrizia ; Stagno, Fabio ; Vigneri, Paolo ; Annunziata, Mario ; Cavazzini, Francesco ; Binotto, Gianni ; Mansueto, Giovanna ; Russo, Sabina ; Falzetti, Franca ; Montefusco, Enrico ; Gugliotta, Gabriele ; Storti, Sergio ; D'Addosio, Ada M. ; Scaffidi, Luigi ; Cortesi, Laura ; Cedrone, Michele ; Rossi, Antonella Russo ; Avanzini, Paolo ; Mauro, Endri ; Spadea, Antonio ; Celesti, Francesca ; Giglio, Gianfranco ; Isidori, Alessandro ; Crugnola, Monica ; Calistri, Elisabetta ; Sorà, Federica ; Rege-Cambrin, Giovanna ; Sica, Simona ; Luciano, Luigiana ; Galimberti, Sara ; Orlandi, Ester M. ; Bocchia, Monica ; Tettamanti, Mauro ; Alimena, Giuliana ; Saglio, Giuseppe ; Rosti, Gianantonio ; Mannucci, Pier Mannuccio ; Cortelezzi, Agostino. / Imatinib and polypharmacy in very old patients with chronic myeloid leukemia : Effects on response rate, toxicity and outcome. In: Oncotarget. 2016 ; Vol. 7, No. 48. pp. 80083-80090.
@article{d2b645f12b7746ab95959172e86299c0,
title = "Imatinib and polypharmacy in very old patients with chronic myeloid leukemia: Effects on response rate, toxicity and outcome",
abstract = "Background: About 40{\%} of all patients with chronic myeloid leukemia are currently old or very old. They are effectively treated with imatinib, even though underrepresented in clinical studies. Furthermore, as it happens in the general population, they often receive multiple drugs for associated chronic illnesses. Aim of this study was to assess whether or not in imatinib-treated patients aged > 75 years the exposure to polypharmacy (5 drugs or more) had an impact on cytogenetic and molecular response rates, event-free and overall survival, as well as on hematological or extra-hematological toxicity. Methods: 296 patients at 35 Italian hematological institutions were evaluated. Results: Polypharmacy was reported in 107 patients (36.1{\%}), and drugs more frequently used were antiplatelets, diuretics, proton pump inhibitors, ACE-inhibitors, beta-blockers, calcium channel blockers, angiotensin II receptors blockers, statins, oral hypoglycemic drugs and alpha blockers. Complete cytogenetic response was obtained in 174 patients (58.8{\%}), 78 (26.4{\%}) within 6 month, 63 (21.3{\%}) between 7 and 12 months. Major molecular response was obtained in 153 patients (51.7{\%}), 64 (21.6{\%}) within the 12 month. One hundred and twenty-eight cases (43.2{\%}) of hematological toxicity were recorded, together with 167 cases (56.4{\%}) of extra-hematological toxicity. Comparing patients exposed to polypharmacy to those without, no difference was observed pertaining to the dosage of imatinib, cytogenetic and molecular responses and hematological and extra-hematological toxicity. Conclusion: Notwithstanding the several interactions reported in the literature between imatinib and some of the medications considered herewith, this fact does not seem to have a clinical impact on response rate and outcome.",
keywords = "Chronic myeloid leukemia, Comorbidities, Imatinib, Old patients, Polypharmacy",
author = "Alessandra Iurlo and Alessandro Nobili and Roberto Latagliata and Cristina Bucelli and Fausto Castagnetti and Massimo Breccia and Elisabetta Abruzzese and Daniele Cattaneo and Carmen Fava and Dario Ferrero and Antonella Gozzini and Massimiliano Bonifacio and Mario Tiribelli and Patrizia Pregno and Fabio Stagno and Paolo Vigneri and Mario Annunziata and Francesco Cavazzini and Gianni Binotto and Giovanna Mansueto and Sabina Russo and Franca Falzetti and Enrico Montefusco and Gabriele Gugliotta and Sergio Storti and D'Addosio, {Ada M.} and Luigi Scaffidi and Laura Cortesi and Michele Cedrone and Rossi, {Antonella Russo} and Paolo Avanzini and Endri Mauro and Antonio Spadea and Francesca Celesti and Gianfranco Giglio and Alessandro Isidori and Monica Crugnola and Elisabetta Calistri and Federica Sor{\`a} and Giovanna Rege-Cambrin and Simona Sica and Luigiana Luciano and Sara Galimberti and Orlandi, {Ester M.} and Monica Bocchia and Mauro Tettamanti and Giuliana Alimena and Giuseppe Saglio and Gianantonio Rosti and Mannucci, {Pier Mannuccio} and Agostino Cortelezzi",
year = "2016",
doi = "10.18632/oncotarget.11657",
language = "English",
volume = "7",
pages = "80083--80090",
journal = "Oncotarget",
issn = "1949-2553",
publisher = "Impact Journals LLC",
number = "48",

}

TY - JOUR

T1 - Imatinib and polypharmacy in very old patients with chronic myeloid leukemia

T2 - Effects on response rate, toxicity and outcome

AU - Iurlo, Alessandra

AU - Nobili, Alessandro

AU - Latagliata, Roberto

AU - Bucelli, Cristina

AU - Castagnetti, Fausto

AU - Breccia, Massimo

AU - Abruzzese, Elisabetta

AU - Cattaneo, Daniele

AU - Fava, Carmen

AU - Ferrero, Dario

AU - Gozzini, Antonella

AU - Bonifacio, Massimiliano

AU - Tiribelli, Mario

AU - Pregno, Patrizia

AU - Stagno, Fabio

AU - Vigneri, Paolo

AU - Annunziata, Mario

AU - Cavazzini, Francesco

AU - Binotto, Gianni

AU - Mansueto, Giovanna

AU - Russo, Sabina

AU - Falzetti, Franca

AU - Montefusco, Enrico

AU - Gugliotta, Gabriele

AU - Storti, Sergio

AU - D'Addosio, Ada M.

AU - Scaffidi, Luigi

AU - Cortesi, Laura

AU - Cedrone, Michele

AU - Rossi, Antonella Russo

AU - Avanzini, Paolo

AU - Mauro, Endri

AU - Spadea, Antonio

AU - Celesti, Francesca

AU - Giglio, Gianfranco

AU - Isidori, Alessandro

AU - Crugnola, Monica

AU - Calistri, Elisabetta

AU - Sorà, Federica

AU - Rege-Cambrin, Giovanna

AU - Sica, Simona

AU - Luciano, Luigiana

AU - Galimberti, Sara

AU - Orlandi, Ester M.

AU - Bocchia, Monica

AU - Tettamanti, Mauro

AU - Alimena, Giuliana

AU - Saglio, Giuseppe

AU - Rosti, Gianantonio

AU - Mannucci, Pier Mannuccio

AU - Cortelezzi, Agostino

PY - 2016

Y1 - 2016

N2 - Background: About 40% of all patients with chronic myeloid leukemia are currently old or very old. They are effectively treated with imatinib, even though underrepresented in clinical studies. Furthermore, as it happens in the general population, they often receive multiple drugs for associated chronic illnesses. Aim of this study was to assess whether or not in imatinib-treated patients aged > 75 years the exposure to polypharmacy (5 drugs or more) had an impact on cytogenetic and molecular response rates, event-free and overall survival, as well as on hematological or extra-hematological toxicity. Methods: 296 patients at 35 Italian hematological institutions were evaluated. Results: Polypharmacy was reported in 107 patients (36.1%), and drugs more frequently used were antiplatelets, diuretics, proton pump inhibitors, ACE-inhibitors, beta-blockers, calcium channel blockers, angiotensin II receptors blockers, statins, oral hypoglycemic drugs and alpha blockers. Complete cytogenetic response was obtained in 174 patients (58.8%), 78 (26.4%) within 6 month, 63 (21.3%) between 7 and 12 months. Major molecular response was obtained in 153 patients (51.7%), 64 (21.6%) within the 12 month. One hundred and twenty-eight cases (43.2%) of hematological toxicity were recorded, together with 167 cases (56.4%) of extra-hematological toxicity. Comparing patients exposed to polypharmacy to those without, no difference was observed pertaining to the dosage of imatinib, cytogenetic and molecular responses and hematological and extra-hematological toxicity. Conclusion: Notwithstanding the several interactions reported in the literature between imatinib and some of the medications considered herewith, this fact does not seem to have a clinical impact on response rate and outcome.

AB - Background: About 40% of all patients with chronic myeloid leukemia are currently old or very old. They are effectively treated with imatinib, even though underrepresented in clinical studies. Furthermore, as it happens in the general population, they often receive multiple drugs for associated chronic illnesses. Aim of this study was to assess whether or not in imatinib-treated patients aged > 75 years the exposure to polypharmacy (5 drugs or more) had an impact on cytogenetic and molecular response rates, event-free and overall survival, as well as on hematological or extra-hematological toxicity. Methods: 296 patients at 35 Italian hematological institutions were evaluated. Results: Polypharmacy was reported in 107 patients (36.1%), and drugs more frequently used were antiplatelets, diuretics, proton pump inhibitors, ACE-inhibitors, beta-blockers, calcium channel blockers, angiotensin II receptors blockers, statins, oral hypoglycemic drugs and alpha blockers. Complete cytogenetic response was obtained in 174 patients (58.8%), 78 (26.4%) within 6 month, 63 (21.3%) between 7 and 12 months. Major molecular response was obtained in 153 patients (51.7%), 64 (21.6%) within the 12 month. One hundred and twenty-eight cases (43.2%) of hematological toxicity were recorded, together with 167 cases (56.4%) of extra-hematological toxicity. Comparing patients exposed to polypharmacy to those without, no difference was observed pertaining to the dosage of imatinib, cytogenetic and molecular responses and hematological and extra-hematological toxicity. Conclusion: Notwithstanding the several interactions reported in the literature between imatinib and some of the medications considered herewith, this fact does not seem to have a clinical impact on response rate and outcome.

KW - Chronic myeloid leukemia

KW - Comorbidities

KW - Imatinib

KW - Old patients

KW - Polypharmacy

UR - http://www.scopus.com/inward/record.url?scp=84998794985&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84998794985&partnerID=8YFLogxK

U2 - 10.18632/oncotarget.11657

DO - 10.18632/oncotarget.11657

M3 - Article

AN - SCOPUS:84998794985

VL - 7

SP - 80083

EP - 80090

JO - Oncotarget

JF - Oncotarget

SN - 1949-2553

IS - 48

ER -