Contributions
Abstract: PB1912
Type: Publication Only
Background
Recent studies have indicated that comorbidity may impact the treatment response and survival of chronic myeloid leukemia (CML) patients treated with tyrosine inhibitors (TKIs). The Charlson Comorbidity Index (CCI) was originally introduced as a tool to measure the influence of relevant comorbid diseases in terms of reduced life expectancies. The score is well established and validated and it is widely used for both hospitalized patients and outpatients.
Aims
The objective of this study was to evaluate the influence of baseline comorbidities on treatment response rate and survival in patients with CML.
Methods
We reviewed the records of patients with newly diagnosed CML between 2006 and 2018, who were receiving imatinib as first line and nilotinib as second line therapy. For this retrospective analysis, patients were divided into two groups with none (CCI 2) or one and more present comorbid conditions (CCI ≥3). The CCI has been used to evaluate concomitant underlying disease at diagnosis as the most extensively studied comorbidity index. Complete cytogenetic response (CCyR) and major molecular response (MMR) have been defined according to the European LeukemiaNet criteria. Overall survival (OS) was calculated from the date of imatinib initiation until death at any time and for any reason.
Results
At the time of analysis, 106 patients could be analysed, of which 57 (53.8%) were female, with median age of 56.4 (18-78) years at imatinib initiation. According to the Euro score, 51.9% patients were classified as low risk, 38.7% as intermediate risk and 9.4% as high risk. EUTOS score was low for 83% of patients. Median follow-up time was 71.5 (6-132) months, and 45 (42.5%) patients had documented comorbidities, 30 (28.3%) with CCI relevant diseases. The distribution of CCI comorbidity risk categories were: diabetes mellitus (n=9), chronic pulmonary disease (n=5), moderate to severe renal insufficiency (n=4), cerebrovascular disease (n=3), peripheral vascular disease (n=3), myocardial infarction (n=2), congestive heart failure (n=2) and peptic ulcer (n=2). The most common comorbidities not considered with the CCI were: arterial hypertension (n=6), angina pectoris (n=3), arrhythmia (n=2), thyroid disfunction (n=2), etc. At 5 years, cumulative incidence of achieving CCyR according to the CCI was similar in both analysed groups: 84.9% in CCI 2 and 78.3% in CCI ≥3. Likewise, no differences in cumulative incidence of MMR has been observed between patients in different CCI groups: 75.5% in CCI2 and 68.9% in CCI≥3. Median time to optimal response for patients with CCI2 or CCI≥3 did not differ within each arm, for CCyR 10.5 vs 11.8 months and for MMR 18.3 vs 19.1 months. However, it was found that patients with comorbidities had significantly shorter OS. Probabilities of OS at 5 years for patients with CCI2 and CCI≥3 were 92.1% (95%CI: 89.5%>95.3%) and 68.9% (95%CI: 62.8%>72.7%), respectively. There were 18 patients in both groups who died during the follow-up, of which 10 patients died due to non-CML related causes while 8 deaths were resulting from progression of CML.
Conclusion
This study indicated that in CML patients’ comorbidities do not affect achievement of therapeutic response, since the possibility of achieving CCyR and MMR was similar regardless of presence or absence of comorbidity. However, comorbidities have significant negative impact on overall survival, as CML patients’ survival is influenced more by comorbidities than by CML itself.
Session topic: 8. Chronic myeloid leukemia - Clinical
Keyword(s): Chronic myeloid leukemia, Comorbidities, Survival
Abstract: PB1912
Type: Publication Only
Background
Recent studies have indicated that comorbidity may impact the treatment response and survival of chronic myeloid leukemia (CML) patients treated with tyrosine inhibitors (TKIs). The Charlson Comorbidity Index (CCI) was originally introduced as a tool to measure the influence of relevant comorbid diseases in terms of reduced life expectancies. The score is well established and validated and it is widely used for both hospitalized patients and outpatients.
Aims
The objective of this study was to evaluate the influence of baseline comorbidities on treatment response rate and survival in patients with CML.
Methods
We reviewed the records of patients with newly diagnosed CML between 2006 and 2018, who were receiving imatinib as first line and nilotinib as second line therapy. For this retrospective analysis, patients were divided into two groups with none (CCI 2) or one and more present comorbid conditions (CCI ≥3). The CCI has been used to evaluate concomitant underlying disease at diagnosis as the most extensively studied comorbidity index. Complete cytogenetic response (CCyR) and major molecular response (MMR) have been defined according to the European LeukemiaNet criteria. Overall survival (OS) was calculated from the date of imatinib initiation until death at any time and for any reason.
Results
At the time of analysis, 106 patients could be analysed, of which 57 (53.8%) were female, with median age of 56.4 (18-78) years at imatinib initiation. According to the Euro score, 51.9% patients were classified as low risk, 38.7% as intermediate risk and 9.4% as high risk. EUTOS score was low for 83% of patients. Median follow-up time was 71.5 (6-132) months, and 45 (42.5%) patients had documented comorbidities, 30 (28.3%) with CCI relevant diseases. The distribution of CCI comorbidity risk categories were: diabetes mellitus (n=9), chronic pulmonary disease (n=5), moderate to severe renal insufficiency (n=4), cerebrovascular disease (n=3), peripheral vascular disease (n=3), myocardial infarction (n=2), congestive heart failure (n=2) and peptic ulcer (n=2). The most common comorbidities not considered with the CCI were: arterial hypertension (n=6), angina pectoris (n=3), arrhythmia (n=2), thyroid disfunction (n=2), etc. At 5 years, cumulative incidence of achieving CCyR according to the CCI was similar in both analysed groups: 84.9% in CCI 2 and 78.3% in CCI ≥3. Likewise, no differences in cumulative incidence of MMR has been observed between patients in different CCI groups: 75.5% in CCI2 and 68.9% in CCI≥3. Median time to optimal response for patients with CCI2 or CCI≥3 did not differ within each arm, for CCyR 10.5 vs 11.8 months and for MMR 18.3 vs 19.1 months. However, it was found that patients with comorbidities had significantly shorter OS. Probabilities of OS at 5 years for patients with CCI2 and CCI≥3 were 92.1% (95%CI: 89.5%>95.3%) and 68.9% (95%CI: 62.8%>72.7%), respectively. There were 18 patients in both groups who died during the follow-up, of which 10 patients died due to non-CML related causes while 8 deaths were resulting from progression of CML.
Conclusion
This study indicated that in CML patients’ comorbidities do not affect achievement of therapeutic response, since the possibility of achieving CCyR and MMR was similar regardless of presence or absence of comorbidity. However, comorbidities have significant negative impact on overall survival, as CML patients’ survival is influenced more by comorbidities than by CML itself.
Session topic: 8. Chronic myeloid leukemia - Clinical
Keyword(s): Chronic myeloid leukemia, Comorbidities, Survival