Assessment of treatment and monitoring patterns and subsequent outcomes among patients with chronic myeloid leukemia treated with imatinib in a community setting

Abstract

Almost one-third of patients initiating imatinib for CP-CML required dose modification, treatment interruption, or discontinuation. Opportunities for improved monitoring in this setting were identified. Limitations include those inherent to retrospective analyses based on EMR and the uncertain extrapolability of the results.

The Effectiveness of Tyrosine Kinase Inhibitors and Molecular Monitoring Patterns in Newly Diagnosed Patients With Chronic Myeloid Leukemia in the Community Setting

“…[19][20][21][22] In the present analysis, the effectiveness of first-line TKIs was investigated in community-based oncology practices. Specifically, we evaluated response rates, adherence, and all-cause discontinuation in patients with CML.…”

Measurement ofBCR-ABL1transcripts on the International Scale in the United States: current status and best practices

“…[28][29][30][31] The availability of multiple TKI treatment choices and the emergence of deep molecular responses as a treatment goal have increased the importance of accurate, precise, and sensitive measurement of BCR-ABL1. Although a number of challenges remain, [13] the widespread adoption of the IS in the United States is an important step toward global standardization of CML data reporting.…”

“…For example, a chart review analysis found that patients with frequent molecular monitoring per ELN guidelines during the first year of treatment were less likely to progress or die on study. [28] A separate chart review analysis found that patients who had 1-2 or 3-4 BCR-ABL1 RQ-PCR tests per year experienced a lower risk of progression than patients who had no BCR-ABL1 RQ-PCR tests. [29] Regular molecular monitoring in patients with CML is also associated with improved treatment compliance [30] and economic benefits.…”

“…[2,5] Although the 30 samples from IRIS upon which the IS baseline level was defined have been exhausted, laboratories are able to calibrate their individual BCR-ABL1 RQ-PCR assays to the IS by either of two methods. The first method requires an exchange of a series of samples (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30), spanning the entire analytic measurement range) with a reference laboratory that has already been calibrated to the IS and that maintains strict quality control standards for BCR-ABL1 RQ-PCR. [13,15,18] Following the sample exchange, a laboratory-specific conversion factor (CF) is derived using linear regression and bias analyses.…”

Omitting cytogenetic assessment from routine treatment response monitoring in chronic myeloid leukemia is safe

“…The importance of frequent monitoring of treatment response in patients with chronic myeloid leukemia (CML) is well established . Timely adjustment of tyrosine kinase inhibitor (TKI) therapy in patients with a failing response is essential to prevent progression from chronic to advanced stage disease as this carries a poor prognosis.…”