Contributions
Abstract: PB1525
Type: Publication Only
Session title: Chronic myeloid leukemia - Clinical
Background
Tyrosine Kinase Inhibitors (TKI) have revolutionised the treatment and outcome of patients with Chronic Myeloid Leukaemia. This treatment, however, is associated with significant toxicity, in particular cardiovascular complications, and emergence of drug resistance. In order to optimise the TKI treatment pathway, European Leukaemia Net (ELN) published a Guidelines in 2013 (Baccarani et al, Blood. 2013;122:872–84). But the recent UK TARGET CML study carried out in the United Kingdom has identified significant variations in compliance with the above guidelines (Milojkovic et al, Br Haematol. Br J Haematol. 192(1):62-74).
Aims
We conducted an audit into the treatment pathway of all patients currently treated with a TKI in our hospital
Methods
Patient demographics, clinical features at presentation, diagnostics, clinical risk assessment, prognostic evaluation, treatment choice, frequency of response monitoring and interventions at treatment failures were analysed in a cohort of 51 (31 male and 20 female) patients.
Results
The age group of this patient population is 24-88 years (mean 59.4). Good clinical records documenting relevant clinical information are available in 40/51 (78%) cases. Cardiac co-morbidities are recorded in 21/51 (41.2%) patients. These include type II diabetes mellitus (11.8%), hypertension (11.8%), cardiac arrhythmias (5.9%), obesity (21.6%), ischaemic heart disease (5.9%) and hyperlipidaemia (1.9%). Relevant clinical signs are recorded in 86% of the cases but this information is missing in 14% of the notes studied. Splenomegaly and hepatomegaly were noted at presentation in 14 (27.4%) and 1 (1.9%) patients respectively. All patients (100%) had bone marrow evaluation and cytogenetics done at diagnosis but prognostic scores are recorded only in 10 (19.6%) cases. The first line TKI was imatinib in 44/51 (86.2%), dasatinib in 4/51 (7.8%) and nilotinib in 3/51 (5.9%). The selection of TKI was appropriate in all 14 patients (100%) with known cardiac risk factor(s). A second generation TKI was selected on the basis of risk assessment in 3 patients. The reason for the selection of a second generation TKI in the other 4 cases was not recorded. 22/51 (43.1%) patients developed treatment failure at various time points. One patient opted for palliative care. Appropriate changes to treatment were made in 18/21 (85%) patients. However, there were delays in introducing changes to treatment in the remaining 3/21 cases (15%). Second line TKI treatment was dasatinib in 10 (47.6%), nilotinib in 6 (28.6%) and imatinib in 5 (23.8%) patients. The choice of second generation TKI was based on cardiovascular risk assessment in 18/21 (85.7%). Tyrosine Kinase Domain mutation analysis was carried out prior to changing TKI in 6/21 (28.6%). The test was not performed in 15/21 (71.4%) cases. The results of the current audit were compared with the previous audit conducted in 2011, prior to the introduction of ELN Guidelines.
Conclusion
The ELN Guidelines have had a positive impact on the CML treatment pathways in our institution with significant improvements in the diagnosis, clinical risk assessment, disease monitoring and drug selection at treatment failure. However, there is still room for further improvements, in particular, in areas of prognostic evaluation, risk-adapted drug choice and TKD mutation analysis at treatment failure.
Keyword(s): Chronic myeloid leukemia, Tyrosine kinase inhibitor
Abstract: PB1525
Type: Publication Only
Session title: Chronic myeloid leukemia - Clinical
Background
Tyrosine Kinase Inhibitors (TKI) have revolutionised the treatment and outcome of patients with Chronic Myeloid Leukaemia. This treatment, however, is associated with significant toxicity, in particular cardiovascular complications, and emergence of drug resistance. In order to optimise the TKI treatment pathway, European Leukaemia Net (ELN) published a Guidelines in 2013 (Baccarani et al, Blood. 2013;122:872–84). But the recent UK TARGET CML study carried out in the United Kingdom has identified significant variations in compliance with the above guidelines (Milojkovic et al, Br Haematol. Br J Haematol. 192(1):62-74).
Aims
We conducted an audit into the treatment pathway of all patients currently treated with a TKI in our hospital
Methods
Patient demographics, clinical features at presentation, diagnostics, clinical risk assessment, prognostic evaluation, treatment choice, frequency of response monitoring and interventions at treatment failures were analysed in a cohort of 51 (31 male and 20 female) patients.
Results
The age group of this patient population is 24-88 years (mean 59.4). Good clinical records documenting relevant clinical information are available in 40/51 (78%) cases. Cardiac co-morbidities are recorded in 21/51 (41.2%) patients. These include type II diabetes mellitus (11.8%), hypertension (11.8%), cardiac arrhythmias (5.9%), obesity (21.6%), ischaemic heart disease (5.9%) and hyperlipidaemia (1.9%). Relevant clinical signs are recorded in 86% of the cases but this information is missing in 14% of the notes studied. Splenomegaly and hepatomegaly were noted at presentation in 14 (27.4%) and 1 (1.9%) patients respectively. All patients (100%) had bone marrow evaluation and cytogenetics done at diagnosis but prognostic scores are recorded only in 10 (19.6%) cases. The first line TKI was imatinib in 44/51 (86.2%), dasatinib in 4/51 (7.8%) and nilotinib in 3/51 (5.9%). The selection of TKI was appropriate in all 14 patients (100%) with known cardiac risk factor(s). A second generation TKI was selected on the basis of risk assessment in 3 patients. The reason for the selection of a second generation TKI in the other 4 cases was not recorded. 22/51 (43.1%) patients developed treatment failure at various time points. One patient opted for palliative care. Appropriate changes to treatment were made in 18/21 (85%) patients. However, there were delays in introducing changes to treatment in the remaining 3/21 cases (15%). Second line TKI treatment was dasatinib in 10 (47.6%), nilotinib in 6 (28.6%) and imatinib in 5 (23.8%) patients. The choice of second generation TKI was based on cardiovascular risk assessment in 18/21 (85.7%). Tyrosine Kinase Domain mutation analysis was carried out prior to changing TKI in 6/21 (28.6%). The test was not performed in 15/21 (71.4%) cases. The results of the current audit were compared with the previous audit conducted in 2011, prior to the introduction of ELN Guidelines.
Conclusion
The ELN Guidelines have had a positive impact on the CML treatment pathways in our institution with significant improvements in the diagnosis, clinical risk assessment, disease monitoring and drug selection at treatment failure. However, there is still room for further improvements, in particular, in areas of prognostic evaluation, risk-adapted drug choice and TKD mutation analysis at treatment failure.
Keyword(s): Chronic myeloid leukemia, Tyrosine kinase inhibitor