Contributions
Abstract: PB1935
Type: Publication Only
Background
Treatment of chronic myeloid leukemia (CML) patients with imatinib (IMA) significantly prolongs survival. Age is still considered as an important prognostic factor, as it is included in Sokal and ELTS risk scores too. However, several previous studies have demonstrated that the treatment with IMA eliminated the negative effect of the age on the response and survival in CML patients.
Aims
The aim of the analysis was to evaluate optimal response, toxicity, overall survival (OS), progression free survival (PFS), event free survival (EFS) and failure free survival (FFS) according to the age of patients at the time of diagnosis (< 65 years vs. ≥ 65 years).
Methods
A total of 372 patients (170 women, 202 men) treated with IMA 400 mg/day in the first line were retrospectively evaluated from CAMELIA registry. The median age of diagnosis was 54 (range: 18 - 88) years. The median follow up was 82.3 (18 – 177.3) months (M). The patients were divided into two groups: age < 65 years (292 patients) and age ≥ 65 years (80 patients). ELN definitions for treatment response were used. For statistical analysis were used Mann-Whitney and Fisher tests, Kaplan-Meier method with the log-rank test was used for survival analysis.
Results
Elderly patients at the time of diagnosis CML had a statistically higher ECOG score (p = 0.001), however leukocyte count and spleen size were statistically lower compared to the younger patients (p = 0.028; p = 0.034). There were no statistically significant differences in achievement of complete hematologic (CHR), complete cytogenetic (CCyR) and major molecular responses (MMR) at the optimal time-points between the two groups. Median time to CHR, CCyR and MMR was not different in both groups (3; 12; 35M in younger vs. 3; 10 and 35M in elderly patients). In the elderly group the incidence of adverse events was higher (p < 0.001) as well as more frequent dose reduction of IMA was required in elderly patients (26.3% vs. 10.3%). There were 35 deaths in the younger group and 18 deaths in the elderly group (12% vs. 22,5%) but the incidence of CML-related death was comparable in both groups (7.5% vs. 6.2%). 10-year OS was 86% vs. 68% (p < 0.001) but OS with CML-related death was 96% vs. 89% without the statistically difference (p = 0.07). Non-significant trend to inferior PFS 68% vs. 84% (p = 0.07) was observed in elderly patients. FFS and EFS showed no the statistical difference between both groups (50% vs. 35%; p = 0.43 and 40% vs. 30%; p = 0.39). Patients with a sustained dose of IMA 400 mg/die have better survival in both patient groups but without the statistically differences (p = 0.06; p = 0.20) (Figure A,B). At present, 173 (67.8%) younger patients and 44 (74.6%) older patients are still treated with IMA.
Conclusion
Our analysis has shown that the achievement of optimal CHR, CCyR and MMR responses is comparable in both groups. Worse overall survival in the group of patients with age ≥ 65 is due to the other causes of death than CML. Currently, age at the time of diagnosis CML has lost its negative prognostic significance. The analysis was supported by a research grant from Novartis.
Session topic: 8. Chronic myeloid leukemia - Clinical
Keyword(s): Age, Chronic myeloid leukemia, imatinib
Abstract: PB1935
Type: Publication Only
Background
Treatment of chronic myeloid leukemia (CML) patients with imatinib (IMA) significantly prolongs survival. Age is still considered as an important prognostic factor, as it is included in Sokal and ELTS risk scores too. However, several previous studies have demonstrated that the treatment with IMA eliminated the negative effect of the age on the response and survival in CML patients.
Aims
The aim of the analysis was to evaluate optimal response, toxicity, overall survival (OS), progression free survival (PFS), event free survival (EFS) and failure free survival (FFS) according to the age of patients at the time of diagnosis (< 65 years vs. ≥ 65 years).
Methods
A total of 372 patients (170 women, 202 men) treated with IMA 400 mg/day in the first line were retrospectively evaluated from CAMELIA registry. The median age of diagnosis was 54 (range: 18 - 88) years. The median follow up was 82.3 (18 – 177.3) months (M). The patients were divided into two groups: age < 65 years (292 patients) and age ≥ 65 years (80 patients). ELN definitions for treatment response were used. For statistical analysis were used Mann-Whitney and Fisher tests, Kaplan-Meier method with the log-rank test was used for survival analysis.
Results
Elderly patients at the time of diagnosis CML had a statistically higher ECOG score (p = 0.001), however leukocyte count and spleen size were statistically lower compared to the younger patients (p = 0.028; p = 0.034). There were no statistically significant differences in achievement of complete hematologic (CHR), complete cytogenetic (CCyR) and major molecular responses (MMR) at the optimal time-points between the two groups. Median time to CHR, CCyR and MMR was not different in both groups (3; 12; 35M in younger vs. 3; 10 and 35M in elderly patients). In the elderly group the incidence of adverse events was higher (p < 0.001) as well as more frequent dose reduction of IMA was required in elderly patients (26.3% vs. 10.3%). There were 35 deaths in the younger group and 18 deaths in the elderly group (12% vs. 22,5%) but the incidence of CML-related death was comparable in both groups (7.5% vs. 6.2%). 10-year OS was 86% vs. 68% (p < 0.001) but OS with CML-related death was 96% vs. 89% without the statistically difference (p = 0.07). Non-significant trend to inferior PFS 68% vs. 84% (p = 0.07) was observed in elderly patients. FFS and EFS showed no the statistical difference between both groups (50% vs. 35%; p = 0.43 and 40% vs. 30%; p = 0.39). Patients with a sustained dose of IMA 400 mg/die have better survival in both patient groups but without the statistically differences (p = 0.06; p = 0.20) (Figure A,B). At present, 173 (67.8%) younger patients and 44 (74.6%) older patients are still treated with IMA.
Conclusion
Our analysis has shown that the achievement of optimal CHR, CCyR and MMR responses is comparable in both groups. Worse overall survival in the group of patients with age ≥ 65 is due to the other causes of death than CML. Currently, age at the time of diagnosis CML has lost its negative prognostic significance. The analysis was supported by a research grant from Novartis.
Session topic: 8. Chronic myeloid leukemia - Clinical
Keyword(s): Age, Chronic myeloid leukemia, imatinib