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.

Chronische myeloische Leukämie

“…Die Frage der Dosis-Reduktion sei aber noch nicht ganz geklärt. So hat die OPTIC-Studie ergeben, dass das Ansprechen bei einer niedrigeren Startdose Ponatinib wesentlich stärker sinkt als die arteriellen Thrombose-Ereignisse [7].…”

“…Asciminib wird daher nicht durch Mutationen der ATP-Bindungstasche beeinträchtigt, die andere TKI wirkungslos machen können. Asciminib erwies sich bei Patienten mit T315I-Mutation ebenfalls wirksam, selbst wenn sie auf Ponatinib nicht mehr ansprachen [8]. Im Vergleich zu Bosutinib erreichten unter Asciminib fast das doppelt so viele Patienten ein molekulares Ansprechen, bei denen zuvor bereits 2 oder mehr TKIs versagt hatten [9].…”

A practical guide to managing hypertension, hyperlipidemia, and hyperglycemia in patients with chronic myeloid leukemia

“…Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm caused by a fusion gene that encodes for the oncoprotein BCR-ABL, with constitutive tyrosine kinase activity ( 1 ); the target for tyrosine kinase inhibitor(s) [TKI(s)] ( 2 ). The introduction of the first generation TKI (imatinib) in 2001, substantially improved CML prognosis with reported survival figures comparable to that of the general population ( 1 , 3 ). The striking results continued with the availability of the second (bosutinib, dasatinib, nilotinib) and third (ponatinib) generation TKIs, by obtaining faster and more effective deep molecular responses, but at the expense of the toxicity profile ( 1 ).…”

“…The striking results continued with the availability of the second (bosutinib, dasatinib, nilotinib) and third (ponatinib) generation TKIs, by obtaining faster and more effective deep molecular responses, but at the expense of the toxicity profile ( 1 ). TKIs are generally safe, and most patients experience mild and transient adverse events ( 3 ). However, there are major concerns about the reported cardiovascular adverse events and toxicity in randomized and observational trials ( 1 ).…”

“…CML patients usually have baseline comorbidities or experience cardiovascular events that precluded them from enrolling in the CML landmark trials ( 4 , 5 ). The evidence for the medical management of the existent or new comorbidities is scarce ( 3 ), and dedicated guidelines are lacking. Herein, this review will discuss some of the most common comorbidities reported in CML patients or associated with their TKI therapy and draft a practical guide on their management in the daily clinical practice.…”