ANALYSIS OF THE INFLUENCE OF AGE ON MAJOR MOLECULAR RESPONSE,DEEP MOLECULAR RESPONSE AND SURVIVAL OUTCOMES IN CHRONIC MYELOID LEUKEMIA (CML) PATIENTS TREATED WITH TYROSINE KINASE INHIBITORS (TKIS).
Author(s): ,
Luis Felipe Casado Montero
Affiliations:
Hematology,Hospital Virgen de la Salud,Toledo,Spain
,
Nuria García-Ormeña
Affiliations:
Hematology,Hospital Virgen de la salud,Toledo,Spain
,
García-Gutiérrez J Valentín
Affiliations:
Hematology,Hospital Ramón y Cajal,Madrid,Spain
,
Pilar Giraldo
Affiliations:
Hematology,CIBERER. CB06/07/1036 Traslational Research Unit,Zaragoza,Spain
,
Manuel Pérez-Encinas
Affiliations:
Hematology,Hospital Clínico Universitario de Santiago de Compostela,Santiago de Compostela,Spain
,
Raquel De Paz
Affiliations:
Hematology,Hospital Universitario La Paz,Madrid,Spain
,
Rosa Ayala
Affiliations:
Hospital Universitario Doce de Octubre,Madrid,Spain
,
Guiomar Bautista
Affiliations:
Hematology,Hospital Universitario Puerta de Hierro,Madrid,Spain
,
Santiago Osorio
Affiliations:
Hematology,Hospital Gregorio Marañon,Madrid,Spain
,
María José Requena
Affiliations:
Hematology,Hospital Severo Ochoa,Leganés,Spain
,
Luis Palomera
Affiliations:
Hematology,Hospital Lozano Blesa,Zaragoza,Spain
,
María Jesús Peñarrubia
Affiliations:
Hematology,Hospital Clínico de Valladolid,Valladolid,Spain
,
Carmen Calle
Affiliations:
Hematology,Hospital Universitario Ciudad Real,Ciudad Real,Spain
,
José Angel Hernádez-Rivas
Affiliations:
Hematology,Hospital Universitario Infanta Leonor,Madrid,Spain
,
Cecile Mba
Affiliations:
Hematology,Hospital Universitario de la Princesa,Madrid,Spain
Juan Luis Steegmann
Affiliations:
Hematology,Hospital Universitario de la Princesa,Madrid,Spain
EHA Library. Casado Montero L. Jun 14, 2019; 266219; PF419
Luis Felipe Casado Montero
Luis Felipe Casado Montero
Contributions
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Abstract

Abstract: PF419

Type: Poster Presentation

Presentation during EHA24: On Friday, June 14, 2019 from 17:30 - 19:00

Location: Poster area

Background
Given the good survival outcome of CML patients treated with TKI, and the prognostic value of age at diagnosis, it is needed to dissect more precisely the relative weight of this variable, considering other prognostic variable of interest.

Aims
We analysed different TKI modalities used as therapy for CML-CP in a long-term analysis of different age group

Methods
In a retrospective cohort analysis, we included data from 874 patients with CML-CP treated in clinical practice with TKI and included in the Spanish Registry of CML (RELMC) (17 hospitals around all the country) between 2000 to 2014. The main aim of the study was to describe long-term outcomes of response such as best major or deep molecular response (MMR and DMR, respectively), and survival, in different age groups.   DMR was defined as MR4or better.

Patients were in first chronic phase treated with TKIs in first line or after IFN alpha. 46% pts were treated only with imatinib (median follow up 73 m), 20% with imatinib and then 2ªGTKIs (follow up 70m), 24% with TKIs after IFN (follow up 149m) and 11% with 2GTKIs in first line (follow up 31 m).  525 were men, 349 women.  Median age: 52 y (14-94).  Indexes distribution as show in table 1.

Results
Age groups: Patients were divided in 3 groups depending age at diagnosis. Group 1: Less than 39 years Group 2: 40-64 years   Group 3  ³ 65 years.  We analysed influence of Sokal score and ELTS score in each group. Patients ³ 65 y had a significantly higher frequency of high score.

MMR: With a median of follow up of 82 months (1-351 months) from diagnosis, 77 months (1-311 months) from first treatment and 70 months (1-191 months) from first TKI treatment, the rates of major molecular response for each group were: G1: 55% G2: 53% G3: 46%.

Deep molecular response: The rates of deep molecular response for each group were : G1: 49%  G2: 46% G3: 47%.  Only those patients with high ELTS and belonging to G2 or G3 had a significantly lower rate of DMR.

Death: Rates for each group were: G1: 7%,  G2: 10%, G3: 28%

CML-related death: Rates for each group were: G1: 3,7%, G2: 4,4% G3: 6,7%)

Long-term survival (OS): Figure1: We analyzed the survival for each age group, and also by age slices of 10 years. We found an statistical significant lower overall survival for each decade after 50 years of age. Sokal and ELTS discriminated significantly when considering the group as a whole, but if we consider the different age groups as defined here, only ELTS adequately discriminated in patients between 40 and 64 years, and in those with ³ 65 years. Neither Sokal nor ELTS did it in the younger group.

Conclusion
In the setting of a multicentric, hospital-based CML registry, treatment with TKIs is very variable, resulting in a great number of sequential combinations of TKI. The rate of major or deep molecular response was similar in all age groups. Only patients with high ELTS in 40-64 y and ³ 65 years group showed worse deep molecular response, and the same applied for OS. In conclusion, in our study ELTS score discriminated better than Sokal score.

 

Session topic: 8. Chronic myeloid leukemia - Clinical

Keyword(s): Chronic myeloid leukemia, Imatinib, Nilotinib

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