Contributions
Abstract: PB1832
Type: Publication Only
Background
The development of tyrosine kinase inhibitors (TKIs) over the last 20 years has dramatically improved the outcomes for patients with every stage of chronic myeloid leukaemia (CML). Since the approval of the first TKI, imatinib, in 2001, there are now currently 5 oral TKIs available. Three are approved for frontline use (imatinib, dasatinib and nilotinib) and 2 others (bosutinib and ponatinib) approved for intolerance or failure of prior TKI. Because CML patients need to continue TKI treatment indefinitely, it is necessary to consider not only differences in potency and progression-free survival, but also TKI induced toxicity and quality of life (QOL) when choosing a TKI.
Aims
The aim of this audit was to determine the impact of TKIs on symptom burden and QOL in patients with CML across multiple centres in Ireland, using the MD Anderson Symptom Inventory (MDASI) tool.
Methods
Across 7 centres in Ireland, a total of 87 CML patients currently on TKIs were identified. The mean age was 60yrs with an equal sex distribution (44 male, 43 female). All of these patients were in chronic phase. 79% of patients were in MMR (major molecular remission) at the time of survey. 53 patients were on imatinib, 19 patients on nilotinib, 13 on dasatinib and 2 on bosutinib. Patients from the 7 centres were surveyed at varying time periods between July 2015 and Feb 2017. Patients were contacted by phone. Symptom burden and QOL were assessed using the MD Anderson Symptom Inventory, an extensively validated tool which includes 13 core and 7 CML-specific symptoms, as well as 6 interference items. The questionnaire took on average 5mins to complete and asked patients to rate their symptoms on a scale of 1-10 as experienced over the preceding 24 hours.
Results
Of the 87 patients surveyed, the most commonly prevailing symptoms were fatigue (72.4%), peripheral oedema (48.3%), disturbed sleep (46%), myalgia (43.7%) and dry mouth (39.1%).The least common symptoms were nausea (20.7%) and vomiting (6.9%). Almost half (49.4%) of patients reported at least 1 severe side effect (a score of 7 or more). The most severe side effects were drowsiness (mean score 6.3), myalgia (mean score 6), fatigue, nausea and vomiting (mean score 5.7 each). There was no significant difference in symptom prevalence or severity among the different TKIs. As regards the perceived interference of symptoms on daily functioning, only 29% reported a score of 7 or more in at least 1 of the 6 interference items (i.e. general activity, mood, work, relations with others, walking and enjoyment of life), and only 14% reported that their enjoyment of life was severely affected (score of 7 or more). Of note, exactly two thirds of patients reported little or no interference with their enjoyment of life (score of 0-3).
Conclusion
As demonstrated in this audit, patients with CML on TKIs frequently experience chronic adverse events. Interestingly, CML patients taking second generation TKIs did not appear to have any difference in frequency or severity of symptoms or in QOL compared to patients on imatinib. Despite excellent survival results obtained with TKIs since 2001, an emphasis needs to be placed on symptom burden and QOL. The potential for adverse events with long term therapy may result in dose adjustments, treatment discontinuation, or nonadherence, all of which may negatively affect treatment efficacy. Therefore, assessment of QOL and the symptom burden experienced by patients with CML is useful to facilitate individual treatment decisions and to improve outcome as well as to evaluate the efficacy of emerging therapies.
Session topic: 8. Chronic myeloid leukemia - Clinical
Keyword(s): Chronic myelomonocytic leukemia, Tyrosine kinase inhibitor
Abstract: PB1832
Type: Publication Only
Background
The development of tyrosine kinase inhibitors (TKIs) over the last 20 years has dramatically improved the outcomes for patients with every stage of chronic myeloid leukaemia (CML). Since the approval of the first TKI, imatinib, in 2001, there are now currently 5 oral TKIs available. Three are approved for frontline use (imatinib, dasatinib and nilotinib) and 2 others (bosutinib and ponatinib) approved for intolerance or failure of prior TKI. Because CML patients need to continue TKI treatment indefinitely, it is necessary to consider not only differences in potency and progression-free survival, but also TKI induced toxicity and quality of life (QOL) when choosing a TKI.
Aims
The aim of this audit was to determine the impact of TKIs on symptom burden and QOL in patients with CML across multiple centres in Ireland, using the MD Anderson Symptom Inventory (MDASI) tool.
Methods
Across 7 centres in Ireland, a total of 87 CML patients currently on TKIs were identified. The mean age was 60yrs with an equal sex distribution (44 male, 43 female). All of these patients were in chronic phase. 79% of patients were in MMR (major molecular remission) at the time of survey. 53 patients were on imatinib, 19 patients on nilotinib, 13 on dasatinib and 2 on bosutinib. Patients from the 7 centres were surveyed at varying time periods between July 2015 and Feb 2017. Patients were contacted by phone. Symptom burden and QOL were assessed using the MD Anderson Symptom Inventory, an extensively validated tool which includes 13 core and 7 CML-specific symptoms, as well as 6 interference items. The questionnaire took on average 5mins to complete and asked patients to rate their symptoms on a scale of 1-10 as experienced over the preceding 24 hours.
Results
Of the 87 patients surveyed, the most commonly prevailing symptoms were fatigue (72.4%), peripheral oedema (48.3%), disturbed sleep (46%), myalgia (43.7%) and dry mouth (39.1%).The least common symptoms were nausea (20.7%) and vomiting (6.9%). Almost half (49.4%) of patients reported at least 1 severe side effect (a score of 7 or more). The most severe side effects were drowsiness (mean score 6.3), myalgia (mean score 6), fatigue, nausea and vomiting (mean score 5.7 each). There was no significant difference in symptom prevalence or severity among the different TKIs. As regards the perceived interference of symptoms on daily functioning, only 29% reported a score of 7 or more in at least 1 of the 6 interference items (i.e. general activity, mood, work, relations with others, walking and enjoyment of life), and only 14% reported that their enjoyment of life was severely affected (score of 7 or more). Of note, exactly two thirds of patients reported little or no interference with their enjoyment of life (score of 0-3).
Conclusion
As demonstrated in this audit, patients with CML on TKIs frequently experience chronic adverse events. Interestingly, CML patients taking second generation TKIs did not appear to have any difference in frequency or severity of symptoms or in QOL compared to patients on imatinib. Despite excellent survival results obtained with TKIs since 2001, an emphasis needs to be placed on symptom burden and QOL. The potential for adverse events with long term therapy may result in dose adjustments, treatment discontinuation, or nonadherence, all of which may negatively affect treatment efficacy. Therefore, assessment of QOL and the symptom burden experienced by patients with CML is useful to facilitate individual treatment decisions and to improve outcome as well as to evaluate the efficacy of emerging therapies.
Session topic: 8. Chronic myeloid leukemia - Clinical
Keyword(s): Chronic myelomonocytic leukemia, Tyrosine kinase inhibitor