Chronic Myelogenous Leukemia  (Cml) in the Elderly

Balducci, Lodovico

doi:10.4084/mjhid.2014.037

Cited by 13 publications

(9 citation statements)

References 10 publications

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“…This is perhaps due to the variety of conditions in which combination therapies were analyzed, adding a level of treatment complexity owing to overlapping PK interactions (i.e. absorption, distribution, metabolism) [ 19 ]. Most importantly, at variance with comorbidities that did significantly influence patient outcome also in the present cohort, concomitant drugs and single classes of drugs failed to affect EFS or OS in old CML patients.…”

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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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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“…CGA can be used to determine a patient's physiological as opposed to chronological age, and whether a patient is fit, vulnerable, or frail, and is useful to help guide future diagnostic and therapeutic interventions . CGA may help define expected life‐expectancy (in order to justify treatment initiation), treatment tolerance, and adjustment of patients' polypharmacy to prevent dangerous drug‐drug interactions …”

Section: Ponatinib In Chronic Myeloid Leukemiamentioning

confidence: 99%

“…51 CGA may help define expected life-expectancy (in order to justify treatment initiation), treatment tolerance, and adjustment of patients' polypharmacy to prevent dangerous drug-drug interactions. 54 The difference between chronological and functional age needs to be integrated into the decision-making process of cancer treatment for each patient, to identify those who are fitter and potentially more resilient, and who are then more likely to benefit from aggressive treatment, as opposed to those who are frailer and more vulnerable to adverse outcomes.…”

Section: The Role Of Ponatinib In the Management Of Elderly Patientsmentioning

confidence: 99%

The multi‐tyrosine kinase inhibitor ponatinib for chronic myeloid leukemia: Real‐world data

Luciano

Annunziata

Attolico³

et al. 2020

European J of Haematology

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Development of the highly selective targeted tyrosine kinase inhibitors (TKIs) has expanded the therapeutic options for chronic myeloid leukemia (CML). Patients undergoing TKI therapy should be closely monitored to ensure that the best therapeutic response and quality of life are achieved, and to control suboptimal responses and adverse events. Despite the high rate of response using current first‐line TKIs, treatment failure may still occur, and resistance is considered a challenge in the treatment of patients with CML. The third‐generation TKI, ponatinib, is a potent orally bioavailable pan BCR‐ABL inhibitor that inhibits both wild‐type and mutant BCR‐ABL1 kinase, including the “gatekeeper” T315I mutation, which is resistant to all other currently available TKIs. This paper reviews the effectiveness, feasibility, and safety of ponatinib in the real‐life clinical management of CML. Potential prognostic factors in identifying patients most likely to benefit from ponatinib treatment will be discussed, and case presentations illustrating situations encountered in real‐life clinical practice are described. Ponatinib is effective in patients who have received prior TKIs in clinical studies as well as under real‐life conditions. Nevertheless, the risk/benefit balance must be evaluated for each patient, particularly considering disease state, mutational status, treatment line, intolerance/resistance to prior TKIs, age, frailty, and specific comorbidities.

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“…For example, younger patients usually are more physically able and may be more willing to undertake dose escalations to improve molecular responses to attempt treatment-free remission (TFR) [74]. Treatment of older patients often includes more dose modifications to avoid drug-drug interactions with concomitant medication [75] and management of comorbidities than in younger patients, in addition to reducing the risk of disease progression and improving general quality of life.…”

Section: Dose Optimization Of Tkismentioning

confidence: 99%

First-line therapy for chronic phase CML: selecting the optimal BCR-ABL1-targeted TKI

Saglio

Jabbour

2017

Leukemia & Lymphoma

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Patients diagnosed with chronic myeloid leukemia (CML) and treated with BCR-ABL1 tyrosine kinase inhibitors (TKIs) have long life spans. Selection of an appropriate first-line therapy can be difficult as both the unique characteristics of each TKI and patient need to be taken into account to find the optimal match. Patient characteristics include comorbidities, concomitant medications, lifestyle, risk factors, BCR-ABL1 transcript type (e.g. b2a2 or b3a2) and additional chromosomal abnormalities. Just as patients differ, side effects, drug-drug interactions, administration plans, dosing schedules and treatment-related expenses across TKIs also vary. Alignment of these characteristics with the appropriate TKI is key to successfully initiating CML treatment. Continued success relies on communication between the patient and the healthcare team, adherence and optimization of therapy once it is initiated. In this review, we discuss these factors, in addition to TKI efficacy and safety, the cost of therapy, the future of treating CML and treatment-free remission.

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Chronic Myelogenous Leukemia (Cml) in the Elderly

Cited by 13 publications

References 10 publications

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

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

The multi‐tyrosine kinase inhibitor ponatinib for chronic myeloid leukemia: Real‐world data

First-line therapy for chronic phase CML: selecting the optimal BCR-ABL1-targeted TKI

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