Age influences initial dose and compliance to imatinib in chronic myeloid leukemia elderly patients but concomitant comorbidities appear to influence overall and event-free survival

Breccia, Massimo; Luciano, Luigiana; Latagliata, Roberto; Castagnetti, Fausto; Ferrero, Dario; Cavazzini, Francesco; Trawinska, Malgorzata; Annunziata, Mario; Stagno, Fabio; Tiribelli, Mario; Binotto, Gianni; Crisà, Elena; Musto, Pellegrino; Gozzini, Antonella; Cavalli, Laura; Madon, E; Iurlo, Alessandra; Russo, Salvatore; Cedrone, Michele; Rossi, Antonella Russo; Pregno, Patrizia; Echavarría‐Pinto, Mauro; Spadea, Antonio; Molica, Matteo; Giglio, Gianfranco; Celesti, Francesca; Sorà, Federica; Storti, Sergio; D'Addosio, Ada; Cambrin, Giovanna Rege; Isidori, Alessandro; Sica, Simona; Abruzzese, Elisabetta; Speccha, Giorgina; Rosti, Gianantonio

doi:10.1016/j.leukres.2014.06.020

Cited by 30 publications

(18 citation statements)

References 15 publications

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“…We included all patients, aged 18 and above, diagnosed with CML (ICD‐9‐CM: 205.1), between January 2000 and December 2010, with follow‐up time defined as December 31, 2011. When the analyzing hazard ratio for Charlson Comorbidity Index (CCI) was used, it has been reported that a higher score on the Charlson comorbidity index was associated with decrease of up to 50% in overall‐ and event‐free survival . There is very little data associating between different comorbidities and general prognosis of CML patients, however we found no better alternative .…”

Section: Methodsmentioning

confidence: 68%

Adjunctive Chinese Herbal Medicine therapy improves survival of patients with chronic myeloid leukemia: a nationwide population‐based cohort study

et al. 2016

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Despite good clinical results of current drugs, a good reason still exists to search for additional therapies for the management of Chronic Myeloid Leukemia (CML). Chinese Herbal Medicine (CHM) has thus far been overlooked by researchers and no data exists on the subject. We studied the impact of adjunctive CHM on the disease course of CML, using mortality as the major outcome measurement. We used the Taiwanese National Health Insurance Research Database to perform a nationwide population‐based cohort study. Our study included CML patients diagnosed between 2000 and 2010. We matched groups according to age, sex, Charlson Comorbidity Index (CCI) score and use of imatinib, and compared the Hazard Ratios (HR) of CHM group and non‐CHM users, as well as characterized trends of prescriptions used for treating CML. 1371 patients were diagnosed with CML in the years examined, of which 466 were included in to this study. We found that the HR of CHM group was significantly lower compared to non‐CHM groups (0.32, 95% CI 0.22–0.48, P < 0.0001). We also established that this association between reduced HR was dose‐dependent, and the longer CHM users received prescriptions, the lower the HR (P < 0.01). We also analyzed the most commonly used herbal products as well as the HR associated to their use, thus providing future research candidates. Our results supply a strong reason to assume that when administered by properly trained physicians, CHM may have a substantial positive impact on the management of CML.

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Section: Methodsmentioning

confidence: 68%

Adjunctive Chinese Herbal Medicine therapy improves survival of patients with chronic myeloid leukemia: a nationwide population‐based cohort study

et al. 2016

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“…Since liver metastasis was the most common type of metastasis pattern in GIST patients, we analyzed the relative prognostic factors and our multivariate analysis resulted showed that < 65 years old, female, married patients, and patients who received surgery might have a better prognosis for GIST with liver metastasis. The poorer prognosis in elder patients might be related to combination with other diseases or reception of less treatment due to higher possibilities of drug side-effects [5,11]. The relationship between sex and prognosis was not clear, but might be correlated with more psychological distress in male patients [14].…”

Section: Discussionmentioning

confidence: 99%

Metastatic pattern and prognosis of gastrointestinal stromal tumor (GIST): a SEER-based analysis

et al. 2019

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Purpose This SEER-based study aimed to explore and analyze the relationship of metastasis of liver, lung and bone of GIST patients and their prognosis. Methods The data of GIST patients were from Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015 and all the statistical analyses were conducted by statistical software package SPSS (Version 22.0). Results A total of 4224 GIST patients were identified, of which 388 (9.19%) patients with liver metastasis, 20 (0.47%) patients with bone metastasis and 32 (0.76%) patients with lung metastasis. There was no significant difference of risk of bone or lung metastasis between patients with and without liver metastasis (P = 0.935). The median overall survival of patients with liver, bone, or lung metastasis was, respectively, 49 months, 18 months, and 20 months, which were all shorter than that of patients without metastasis. The overall survival of patients with both liver and bone metastasis and those with metastasis of all three sites was not significantly different from that of patients with only liver metastasis. The multivariate analysis showed age of less than 65 years, female patients, married status and receiving surgery were all the beneficial factors for prognosis of GIST patients with liver metastasis. Conclusions Patients with metastasis had a poorer prognosis than those without. Liver metastasis might have no relationship with bone or lung metastasis and liver might play a more dominant role than the other two sites in the prognosis of GIST patients with metastasis. So, more attention should be paid to liver status in diagnosis and treatment of GIST patients.

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“…While the prognostic impact of comorbidities on CML has been previously studied, establishing their strong negative influence [6, 16], there are no data concerning the role that multiple drugs may have regarding response rate or outcome during imatinib therapy in very old CML patients. Indeed, there is a list of observed or potential DDIs between first and second generation TKIs (imatinib, dasatinib and nilotinib) and commonly used drugs which are concomitantly prescribed [13, 17], but this list is mainly the result of meta-analyses regarding in vitro studies rather than of in vivo studies.…”

Section: Discussionmentioning

confidence: 99%

Imatinib and polypharmacy in very old patients with chronic myeloid leukemia: effects on response rate, toxicity and outcome

et al. 2016

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BackgroundAbout 40% of all patients with chronic myeloid leukemia are currently old or very old. They are effectively treated with imatinib, even though underrepresented in clinical studies. Furthermore, as it happens in the general population, they often receive multiple drugs for associated chronic illnesses. Aim of this study was to assess whether or not in imatinib-treated patients aged >75 years the exposure to polypharmacy (5 drugs or more) had an impact on cytogenetic and molecular response rates, event-free and overall survival, as well as on hematological or extra-hematological toxicity.Methods296 patients at 35 Italian hematological institutions were evaluated.ResultsPolypharmacy was reported in 107 patients (36.1%), and drugs more frequently used were antiplatelets, diuretics, proton pump inhibitors, ACE-inhibitors, beta-blockers, calcium channel blockers, angiotensin II receptors blockers, statins, oral hypoglycemic drugs and alpha blockers. Complete cytogenetic response was obtained in 174 patients (58.8%), 78 (26.4%) within 6 month, 63 (21.3%) between 7 and 12 months. Major molecular response was obtained in 153 patients (51.7%), 64 (21.6%) within the 12 month. One hundred and twenty-eight cases (43.2%) of hematological toxicity were recorded, together with 167 cases (56.4%) of extra-hematological toxicity. Comparing patients exposed to polypharmacy to those without, no difference was observed pertaining to the dosage of imatinib, cytogenetic and molecular responses and hematological and extra-hematological toxicity.ConclusionNotwithstanding the several interactions reported in the literature between imatinib and some of the medications considered herewith, this fact does not seem to have a clinical impact on response rate and outcome.

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Age influences initial dose and compliance to imatinib in chronic myeloid leukemia elderly patients but concomitant comorbidities appear to influence overall and event-free survival

Cited by 30 publications

References 15 publications

Adjunctive Chinese Herbal Medicine therapy improves survival of patients with chronic myeloid leukemia: a nationwide population‐based cohort study

Adjunctive Chinese Herbal Medicine therapy improves survival of patients with chronic myeloid leukemia: a nationwide population‐based cohort study

Metastatic pattern and prognosis of gastrointestinal stromal tumor (GIST): a SEER-based analysis

Imatinib and polypharmacy in very old patients with chronic myeloid leukemia: effects on response rate, toxicity and outcome

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