Analysis of outcomes in adolescents and young adults with chronic myelogenous leukemia treated with upfront tyrosine kinase inhibitor therapy

Abstract

BackgroundOutcomes in chronic myeloid leukemia have improved with tyrosine kinase inhibitor treatment. However, little is known about outcomes of chronic myeloid leukemia in adolescent and young adult patients. Design and MethodsWe reviewed all 468 chronic myeloid leukemia patients treated at our institution with tyrosine kinase inhibitors as initial therapy: imatinib (n=281), nilotinib (n=98) or dasatinib (n=89). ResultsMedian age was 47 years, median follow up 71 months and median treatment time with initial tyrosine kinase inhibitors 48 months. Adolescent and young adult was defined as aged 15-29 years. Sixty-one adolescent and young adult patients were identified. The only significant differences between adolescent and young adult and older patients were incidence of splenomegaly and distribution in Sokal risk groups. Only 3 adolescent and young adult patients have died. Rates of complete cytogenetic, major molecular and complete molecular response were significantly higher in older patients compared to adolescent and young adult patients, with a favorable trend in event-free survival for older patients. Transformation-free and overall survival were similar for the two groups. ConclusionsThe unfavorable trend in outcome for adolescent and young adult patients with chronic myeloid leukemia is unexpected. Additional research in this population is required to better define outcomes, understand the cause of this difference, and to help make better treatment recommendations.Key words: chronic myelogenous leukemia, tyrosine kinase inhibitor, adolescent, young adult, outcome. Haematologica 2012;97(7):1029-1035. doi:10.3324/haematol.2011 This is an open-access paper. Citation: Pemmaraju N, Kantarjian H, Shan J, Jabbour E, Quintas-Cardama A, Verstovsek S, Ravandi F, Wierda W, O'Brien S, and Cortes J. Analysis of outcomes in adolescents and young adults with chronic myelogenous leukemia treated with upfront tyrosine kinase inhibitor therapy. Analysis of outcomes in adolescents and

European LeukemiaNet recommendations for the management of chronic myeloid leukemia: 2013

“…The problem of children and adolescents, and also of young adults, is of particular concern. It is believed and recommended [165][166][167] that children must be managed and treated like adults, but specific data are limited and more information pertaining to these particular age groups is necessary.…”

Two cases of chronic myeloid leukemia in pediatric and young adolescent age group

“…There is also much scarcity of available literature on the characteristic, presentation, outcome in this age group, although it has been noted recently by many researchers that, they differ significantly from the much commonly affected elderly population. 7 Although in these two cases, reaching the diagnosis was easily possible, still recent increase in the incidence of CML is not in conformity with the existing experience of the clinicians in our country. This type of disease may pose as diagnostic dilemma for unsuspecting eyes.…”

“…They also found that in this age group, second generation tyrosine kinase inhibitors conferred a better outcome compared to imatinib with a higher rate of complete cytogenic response (CCyR). 7 The reason behind this could be explained by many biological or psychological factors, which are yet not researched . For example, in 41 patients taking imatinib, it was found that body weight was the only variable that was significantly related to imatinib clearance and body weight can frequently be a rapidly changing parameter in many adolescents and young adult patients.…”

“…Incidence of CML in this age group merits much attention as outcome and response to standard treatment often differs significantly from the adult group. 7 We here report two cases of pediatric and young adolescent CML.…”

Response dynamics of pediatric patients with chronic myeloid leukemia on imatinib therapy

“…Rick Proschmann, 1 Christoph Baldow, 1 Tino Rothe, 1 Meinolf Suttorp, 2 Christian Thiede, 3 Josephine T. Tauer, 2 Martin C. Müller, 4 Andreas Hochhaus, 5 Ingo Roeder 1,6 and Ingmar Glauche …”