LONG-TERM FOLLOW-UP IN VERY ELDERLY PATIENTS WITH CHRONIC MYELOID LEUKEMIA TREATED WITH IMATINIB FRONTLINE
Author(s): ,
Monica Crugnola
Affiliations:
Hematology,Azienda Ospedaliero Universitaria Parma,Parma,Italy
,
Roberto Latagliata
Affiliations:
Department of Cellular Biotechnologies and Hematology, University' la Sapienza' of Rome,Rome,Italy
,
Massimo Breccia
Affiliations:
Department of Cellular Biotechnologies and Hematology, University' la Sapienza' of Rome,Rome,Rome,Italy
,
Dario Ferrero
Affiliations:
Hematology Unit,University of Turin,Turin,Italy
,
Malgorzata Monica Trawinska
Affiliations:
Hematology, S.Eugenio Hospital,Tor Vergata,University of Rome,Rome,Italy
,
Fausto Castagnetti
Affiliations:
Institute of Hematology 'L and A Seragnoli', Department of Experimental Hematology, Diagnostic and Speciality Medicine,S.Orsola Malpighi University Hospital,Bologna,Italy
,
Mario Annunziata
Affiliations:
Hematology,Ospedale Cardarelli,Napoli,Italy
,
Fabio Stagno
Affiliations:
Hematology,Ospedale Ferrarotto,Catania,Italy
,
Mario Tiribelli
Affiliations:
Division of hematology and BMT,Azienda Ospedaliero Universitaria Udine,Udine,Italy
,
Gianni Binotto
Affiliations:
Hematology Unit,University of Padova,Padova,Italy
,
Carmen Fava
Affiliations:
Division of Hematology and Internal Medicine, University of Turin 'San Luigi Gonzaga',University Hospital Orbassano,Turin,Italy
,
Elena Crisà
Affiliations:
Hematology University Turin,Turin,Italy
,
Giovanna Mansueto
Affiliations:
Department of Onco-Hematology,IRCS-CROB,Rionero in Volture,Italy
,
Antonella Gozzini
Affiliations:
Hematology,AOU Careggi, University of Florence,Florence,Italy
,
Franca Falzetti
Affiliations:
Division of Hematology and Clinical Immunology, Department of Medicine,University of Perugia,Perugia,Italy
,
Enrico Montefusco
Affiliations:
Hematology Unit,San Andrea Hospital,Rome,Italy
,
Alessandra Iurlo
Affiliations:
Oncohematology Division, IRCCS Ca'Granda-Maggiore PoliclinicoHospital Fundation,University of Milan,Milan,Italy
,
Sabina Russo
Affiliations:
Hematology,University,Messina,Italy
,
Michele Cedrone
Affiliations:
Hematology Unit,San Giovanni Hospital,Rome,Italy
,
Antonella Russo Rossi
Affiliations:
Hematology and Transplantation Unit,University of Bari,Bari,Italy
,
Gabriele Gugliotta
Affiliations:
Institute of Hematology 'L and A Seragnoli', Department of Experimental, Diagnostic and Speciality Medicine 'S Orsola Malpighi',University Hospital, University of Bologna,Bologna,Italy
,
Patrizia Pregno
Affiliations:
Hematology Unit,Azienda Ospedaliero Universitaria Città della Salute e della Scienza,Turin,Italy
,
Alessandro Isidori
Affiliations:
Hematology Unit,Pesaro Hospital,Pesaro,Italy
,
Endri Mauro
Affiliations:
Department of Internal Medicine,Pordenone General Hospital,Pordenone,Italy
,
Romano Atelda
Affiliations:
Hematology Unit,IFO Regina Elena,Roma,Italy
,
Gianfranco Giglio
Affiliations:
Hematology Unit,Ospedale Civile,Campobassano,Italy
,
Francesca Celesti
Affiliations:
Hematology Unit,Ospedale Belcolle,Viterbo,Italy
,
Federica Sorà
Affiliations:
Institute of Hematology,Università cattolica Sacro Cuore,Rome,Italy
,
Sergio Storti
Affiliations:
Oncohematology Unit,Università Cattolica Giovanni Paolo II,Roma,Italy
,
Ada M D'Addosio
Affiliations:
Immunohematology and Trasfusional Medicine Division,,S.Pietro Fatebenefratelli Hospital,Rome,Italy
,
Sara Galimberti
Affiliations:
Department of Clinical and Experimental medicine, Section of Hematology,University of Pisa,Pisa,Italy
,
Ester Orlandi
Affiliations:
Oncology-Hematology Department Hematology Unit,Fondazione IRCCS Policlinico San Matteo,Pavia,Italy
,
Elisabetta Calistri
Affiliations:
Hematology Unit,Treviso Hospital,Treviso,Italy
,
Monica Bocchia
Affiliations:
Hematology Unit,Azienda Ospedaliero Universitaria Senese and university of Siena,Siena,Italy
,
Francesco Cavazzini
Affiliations:
Hematology Unit,University of Ferrara,Ferrara,Italy
,
Giovanna Rege Cambrin
Affiliations:
Division of Hematology and Internal Medicine University of Turin,'San Luigi Gonzaga' University Hospital,Orbassano,Italy
,
Luigiana Luciano
Affiliations:
Hematology Unit 'Federico II Hospital,University of Naples,Naples,Italy
,
Elisabetta Abruzzese
Affiliations:
Hematology Unit,'San Eugenio Hospital',Rome,Italy
Isabella Capodanno
Affiliations:
Hematology Unit,Arcispedale Santa Maria Nuova IRCCS,Reggio Emilia,Italy
EHA Library. Crugnola M. Jun 24, 2017; 181891; P604
Dr. Monica Crugnola
Dr. Monica Crugnola
Contributions
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Abstract

Abstract: P604

Type: Poster Presentation

Presentation during EHA22: On Saturday, June 24, 2017 from 17:30 - 19:00

Location: Poster area (Hall 7)

Background
Very elderly (>75 yrs) people are a substantial proportion of chronic myeloid leukemia (CML) patients that sometimes receive Imatinib (IM) at reduced doses based on physicians’ judgment. However, data on long-term follow-up of these patients are still lacking. 

Aims
To investigate the treatment response and outcome in a cohort of very elderly patients with newly diagnosed CML in chronic phase.

Methods

We revised in a retrospective database 263 CML patients aged ≥ 75 years and diagnosed from 2/2002 to 1/2016 and treated with IM frontline; among these, 121 patients (46%) were older than 80 yrs.

Results
Median age at diagnosis was 78.5 yrs [interquartile range (IQR) [76.3–81.3]. Sokal Risk at diagnosis was low in 1 patient (0.4%), intermediate in 171 (68.4%), high in 78 (31.2%) and not evaluable in 13 patients. As regards comorbidities, 63 patients had no or 1 concomitant disease, 147 patients 2 or 3 and 53 patients (20.1%) 4 or more. Median interval from diagnosis to IM start was 0.8 month (IQR 0.3 – 1.6): the initial IM dose was 400 mg/day in 180 (68.4%), 300 mg/day in 67 (25.5%) and <300 mg/day in 16 (6.1%) patients. According to WHO, grade 3-4 haematological and extra-haematological toxicities were reported in 57 (21,7%) and 51 (19.4%) patients, respectively. As regards cumulative response, 13 patients (4.9%) discontinued IM due to early toxicity, 4 (1.5%) were resistant and 2 (0.8%) died from unrelated causes early after IM initiation; 250 patients (92.8%) achieved a complete haematological response (CHR). Among these, 208 (79% of all 263 patients) achieved a cytogenetic response (CyR), which was partial in 18 patients and complete (CCyR) in 190 (72.2% ) after a median period of 6.1 months since IM initiation (IQR 3.4-9.1). Among the 190 patients in CCyR, 148 (56.2%) achieved a molecular response (MMolR) (ratio < 0.1) after a median period time of 13.7 months (IQR 9.0-22.3). Eleven patients (4.2%) developed a blastic phase (myeloid in 8 and lymphoid in 3 cases). After a median follow-up of 45.0 months from IM start (IQR 22.3– 72.0), 93 patients have died (9 from disease progression and 84 from unrelated causes), 144 are alive and 104 of them are still in treatment with IM, while 8 discontinued for prolonged deep molecular response and 22 switched to 2nd generation TKI. Five-years event-free survival (EFS) and overall survival (OS) were 51.2% (CI95% 44.8-57.6) and 70.9% (CI95% 64.6-77.2), respectively. At univariate analysis Hb level at diagnosis (> 12 vs < 12 g/dl, p=0.021) and the initial dose of IM (400 vs<300, p=0.048) were significant predictive factors for CCyR achievement, while PLT count at diagnosis (>500 vs < 500 x 109/l, p=0.006) and female gender (p=0.046) were significant predictive factors for MMolR achievement. Multivariate analysis for EFS and OS are described in Table1. 

Multivariate analysis for EFS
OR
95% CI
P
400 mg IM initial dose
0.656
0.459 - 0.938
0,021
PLTS < 500 x 109/l
1.517
1.064 - 2.161
0.021
Concomitant diseases ≤ 3
0.597
0.398 - 0.896
0.013
Multivariate analysis for OS
OR
95% CI
P
MMolR achievement
0.363
0.236 - 0.560
<0,001
Age < 80 years
0.622
0.397 - 0.975
0.038
Male gender
1.589
1.048 - 2.410
0.029

Conclusion

The long term follow-up of very elderly CML patients treated with IM suggests that any effort to treat these patients with standard doses should be made, in order to achieve cytogenetic and molecular responses as in younger subjects.

Session topic: 8. Chronic myeloid leukemia - Clinical

Keyword(s): Tyrosine kinase inhibitor, Outcome, Elderly, Chronic myeloid leukemia

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