myeloid leukemia: a retrospective multicenter study

myeloid leukemia: a retrospective multicenter study

THE CLINICAL CHARACTERISTICS AND THERAPEUTIC OUTCOMES OF
ELDERLY PATIENTS WITH CHRONIC M YELOID LEUKEMIA: A
RETROSPECTIVE MULTICENTER STUDY
1
Serdal Korkmaz, 2 Mehmet Sinan Dal, 3 İlhami Berber, 4 Deniz Gören Sahin, 5 Mehmet Hilmi
Dogu,
2
Orhan Ayyildiz,
3
İlknur Nizam,
Namdaroglu, 1 Mehmet Sencan,
10
4
6
Murat Albayrak,
Olga Meltem Akay,
5
7
Ramazan Esen,
Sibel Hacioglu,
9
8
Sinem
Rahsan Yildirim,
Ali Eser, 11 Anil Tombak, , 12 Cigdem Pala, 13 Osman Ilhan.
1
Cumhuriyet University, Department of Hematology, Sivas, Turkey,
2
Dicle University, Department of Hematology, Diyarbakir, Turkey,
3
Inonu University, Department of Hematology, Malatya, Turkey,
4
Osmangazi University, Department of Hematology, Eskisehir, Turkey,
5
Pamukkale University, Department of Hematology, Denizli, Turkey,
6
Diskapi Yildirim Beyazit Education and Research Hospital, Department of Hematology,
Ankara, Turkey,
7
Yuzuncu Yil University, Department of Hematology, Van, Turkey,
8
Ankara Oncology Education and Research Hospital, Department of Hematology, Ankara,
Turkey,
9
Atatürk University, Department of Hematology, Erzurum, Turkey,
10
Marmara University, Department of Hematology, Istanbul, Turkey,
11
Mersin University, Department of Hematology, Mersin, Turkey,
12
Erciyes University, Department of Hematology, Kayseri, Turkey.
13
Ankara University, Ibni Sina Hospital, Department of Hematology, Ankara, Turkey,
Background: We aimed to investigate if older age leads to limitations in starting dose of
imatinib in daily practice of chronic myeloid leukemia (CML) and the compliance with
tyrosine kinase inhibitors (TKIs) therapy in elderly patients.
Methods: To analyze the clinical characteristics and therapeutic outcomes of elderly patients
with CML aged >65 years, data were collected from 13 institutions in Turkey, retrospectively.
Results: A total of 69 cases were evaluated retrospectively. Of the patients, 42 (60.9%) were
females. The median age was 71 years (range; 66-85). Ninety-six percent (66/69) of the
patients were in chronic phase when diagnosed. Of the patients, 3 (4.3%) were in accelerated
phase. The Sokal risk at diagnosis was low in 3 patients, intermediate in 29 patients, and high
in 37 patients. RT-PCR was the most used method to diagnose patients. Sixty-three (91.3%)
patients were under imatinib tharapy as first line. The initial dose of imatinib was 400 mg/day
in 59 (93.6%) patients, 100 mg/day in 2 (3.2%) patients, 300 mg/day in one (1.6%) patient,
and 600 mg/day in one (1.6%) patient. Imatinib treatment induced 57 (90.5%) complete
hematologic responses (CHR) at 3 months and 29 (46%) complete cytogenetic responses
(CCyR) at 6 months, and 49 (77.7%) major molecular responses (MMR) at 12 months. Of the
patients, 2 have discontinued imatinib for hematologic and/or non- hematologic toxicities; as a
result of resistance in 7 patients, and loss of MMR in 5 patients, nilotinib and dasatinib were
used in 14 patients as second- line therapy. Second- line TKIs induced 9 (64.3%) CHR at 3
months and 4 (28.6%) CCyR at 12 months, and 7 (50%) MMR at 18 months. None of the
patients received hematopoietic stem cell transplantation. Fifty-six (81.2%) of the patients are
still alive and being followed up regularly. Of the patients, 11 died of unrelated causes, and 2
died of chemotherapy related events. The median overall survival and progression free
survival rates were 35 months (range; 1-95) and 17 months (range; 0.8-95), respectively.
Conclusions: No need to reduce starting dose of imatinib and no upper age limit should be
applied for the administration of TKIs to elderly patients with CML. Elderly patients should
receive TKIs according to the same guidelines that apply to younger patients.
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