Contributions
Abstract: PB1920
Type: Publication Only
Background
Despite the availability of multiple guidelines for the management of chronic myeloid leukemia (CML), technical, financial and educational challenges, among others, may prevent some physicians from implementing these recommendations. In this context, the TARGET survey was developed by a Steering Committee consisting of 8 international hematologists (from Australia, China, India, Qatar, Russia, Saudi Arabia, South Korea, and Turkey).
Aims
The aims of the TARGET survey were to: I. Assess the current care of patients with CML in the participating countries compared with international guideline recommendations; II. Identify the challenges faced by physicians in implementing these recommendations; III. Develop practical solutions to support physicians in optimizing the management of CML patients.
Methods
Data were collected via a self-administered questionnaire, completed online, from 1-Apr-17 to 31-Aug-17. It included 23 questions divided into 7 sections (physician’s profile, CML diagnosis, molecular monitoring and mutation analysis, treatment objectives, treatment efficacy, treatment toxicities, treatment discontinuation) and 7 clinical cases. The survey covered multiple regions worldwide (Africa, Asia, Australia, Middle East, Russia & Turkey) with 33 participating countries and was available in English, Russian, Turkish and Chinese. The analysis was performed using MODALISA software. Results are reported descriptively.
Results
Of the 1008 physicians contacted, 614 completed the questionnaire. The majority (59%) were male and practiced in Russia (19%), China (13%), India (12%), Turkey (8%) & S.Korea (7%). Most respondents (67%) had been treating CML for >10 years; 30% had personally seen 20-50 CML patients in the previous year. Molecular monitoring: 26% did not have access to a standardised PCR test and a further 52% were unaware of when the last standardization had occurred. Despite 89% of respondents knowing that BCR-ABL levels should be assessed every 3 mths in the first 12 mths of treatment, this was only achieved in clinical practice for 51% of respondents with cost being the main barrier (48%). Treatment toxicities: 4% respondents would change treatment for persistent Grade 1 adverse events (AEs). In contrast, 81% & 90% would do so for Grade 3/4 hematological & nonhematological AEs. Opinions were divided in the case of persistent Grade 2 AEs (59% would switch for nonhematological AEs). Treatment Free Remission (TFR) was considered by few (6%) as their primary treatment goal. Achieving deep molecular response was recognized by 47% as a prerequisite for TFR. The major hurdles for attempting TFR in current practice were lack of guidelines (30%), and insufficient molecular monitoring capability (21% - frequency and/or sensitivity). Management of patients with a “warning” response also yielded mixed responses based on the clinical cases: 53% followed the ELN guideline recommendation of ‘watch & wait’ whilst 47% adjusted the hypothetical patient’s treatment. Similarly, in the clinical case study of a patient receiving imatinib 400mg/day with an optimal response (MMR at 12 mths) but not in deep molecular response at 24 mths, 41% would change the patient’s treatment.
Conclusion
The TARGET survey identified several gaps in current CML management when compared with international guidelines. Practical solutions to address these gaps are currently being developed.
Session topic: 8. Chronic myeloid leukemia - Clinical
Keyword(s): Chronic myeloid leukemia, Clinical outcome
Abstract: PB1920
Type: Publication Only
Background
Despite the availability of multiple guidelines for the management of chronic myeloid leukemia (CML), technical, financial and educational challenges, among others, may prevent some physicians from implementing these recommendations. In this context, the TARGET survey was developed by a Steering Committee consisting of 8 international hematologists (from Australia, China, India, Qatar, Russia, Saudi Arabia, South Korea, and Turkey).
Aims
The aims of the TARGET survey were to: I. Assess the current care of patients with CML in the participating countries compared with international guideline recommendations; II. Identify the challenges faced by physicians in implementing these recommendations; III. Develop practical solutions to support physicians in optimizing the management of CML patients.
Methods
Data were collected via a self-administered questionnaire, completed online, from 1-Apr-17 to 31-Aug-17. It included 23 questions divided into 7 sections (physician’s profile, CML diagnosis, molecular monitoring and mutation analysis, treatment objectives, treatment efficacy, treatment toxicities, treatment discontinuation) and 7 clinical cases. The survey covered multiple regions worldwide (Africa, Asia, Australia, Middle East, Russia & Turkey) with 33 participating countries and was available in English, Russian, Turkish and Chinese. The analysis was performed using MODALISA software. Results are reported descriptively.
Results
Of the 1008 physicians contacted, 614 completed the questionnaire. The majority (59%) were male and practiced in Russia (19%), China (13%), India (12%), Turkey (8%) & S.Korea (7%). Most respondents (67%) had been treating CML for >10 years; 30% had personally seen 20-50 CML patients in the previous year. Molecular monitoring: 26% did not have access to a standardised PCR test and a further 52% were unaware of when the last standardization had occurred. Despite 89% of respondents knowing that BCR-ABL levels should be assessed every 3 mths in the first 12 mths of treatment, this was only achieved in clinical practice for 51% of respondents with cost being the main barrier (48%). Treatment toxicities: 4% respondents would change treatment for persistent Grade 1 adverse events (AEs). In contrast, 81% & 90% would do so for Grade 3/4 hematological & nonhematological AEs. Opinions were divided in the case of persistent Grade 2 AEs (59% would switch for nonhematological AEs). Treatment Free Remission (TFR) was considered by few (6%) as their primary treatment goal. Achieving deep molecular response was recognized by 47% as a prerequisite for TFR. The major hurdles for attempting TFR in current practice were lack of guidelines (30%), and insufficient molecular monitoring capability (21% - frequency and/or sensitivity). Management of patients with a “warning” response also yielded mixed responses based on the clinical cases: 53% followed the ELN guideline recommendation of ‘watch & wait’ whilst 47% adjusted the hypothetical patient’s treatment. Similarly, in the clinical case study of a patient receiving imatinib 400mg/day with an optimal response (MMR at 12 mths) but not in deep molecular response at 24 mths, 41% would change the patient’s treatment.
Conclusion
The TARGET survey identified several gaps in current CML management when compared with international guidelines. Practical solutions to address these gaps are currently being developed.
Session topic: 8. Chronic myeloid leukemia - Clinical
Keyword(s): Chronic myeloid leukemia, Clinical outcome