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

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Keywords

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

ASJC Scopus subject areas

  • Oncology

Cite this

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., ... Cortelezzi, A. (2016). Imatinib and polypharmacy in very old patients with chronic myeloid leukemia: Effects on response rate, toxicity and outcome. Oncotarget, 7(48), 80083-80090. https://doi.org/10.18632/oncotarget.11657