How to manage CML patients with comorbidities

Abstract

Patients with chronic myeloid leukemia (CML) often have comorbidities, at an incidence that might be higher than in the general population. Because of the favorable outcome of most patients with CML treated with tyrosine kinase inhibitors (TKIs), a greater number of comorbidities might be the most significant adverse feature for long-term survival. The presence of comorbidities may also affect the risk of developing adverse events with TKIs. This effect is perhaps best exemplified by the risk of developing arterio-occlusive events, which is greatest for patients who have other risk factors for such events, with the risk increasing with higher numbers of comorbidities. The coexistence of comorbidities in patients with CML not only may affect TKI selection but also demands close monitoring of the overall health condition of the patient to optimize safety and provide the opportunity for an optimal outcome to such patients. With optimal, holistic management of leukemia and all other conditions afflicting them, patients with CML and comorbidities may aim for a near-normal life expectancy, just as the more select patients enrolled in clinical trials now enjoy.

Prognostic Factors for Overall Survival In Chronic Myeloid Leukemia Patients: A Multicentric Cohort Study by the Italian CML GIMEMA Network

“…The principal strength of this large prospective and representative national cohort is that the TKI choice was performed according to a "patient-centered approach", considering at baseline the prognostic role of age, concomitant comorbidities, prognostic score stratification and all the possible concomitant factors that could have influenced the adherence in the long-term (27,28). Although the comparison between treatments has been adjusted for a set of pre-defined important prognostic factors, and the causes of death analyzed separately, the observational study design does not allow the role of uncontrolled or residual confounding to be excluded.…”

Severe obesity in a patient on long-term treatment of chronic myeloid leukemia with imatinib: Body composition, associated disorders and outcome

“…Prevention of cardiovascular toxicity is another important point to consider in CML patients with severe obesity. In fact, diet and weight management have been described as the letter D in the ABCDE steps to prevent cardiovascular disease in patients with CML treated with a TKI [24].…”

Management of Chronic Myeloid Leukemia in Children and Young Adults

“…Cardiovascular side effects, specifically vaso-occlusive events, are of particular concern with the use of second-and third-generation TKIs in adults [24]. While this can cause provider reluctance to use second-and third-generation TKIs especially in older adults with preexisting morbidities [25], there are no serious side effects published within the pediatric literature to date [21,22]. In addition, comorbidities in children are less common; therefore, there may be less concern for these side effects with later generation TKIs.…”