Impact of age on the outcome of patients with chronic myeloid leukemia in late chronic phase: results of a phase II study of the GIMEMA CML Working Party

Rosti, Gianantonio; Iacobucci, Ilaria; Bassi, Simona; Castagnetti, Fausto; Amabile, Marilina; Cilloni, Daniela; Poerio, Angela; Soverini, Simona; Palandri, Francesca; Cambrin, Giovanna Rege; Iuliano, F.; Alimena, Giuliana; Latagliata, Roberto; Testoni, Nicoletta; Pane, Fabrizio; Saglio, Giuseppe; Baccarani, Michele; Martinelli, Giovanni

doi:10.3324/haematol.10239

Cited by 60 publications

(36 citation statements)

References 20 publications

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“…A recent retrospective survey from the GIMEMA group evaluated patients from three CML trials who were over the age of 65 and treated with IM as frontline therapy. Results were similar to those reported here [16,17]. The median age of these 115 patients was 71 years (vs. 74.8 years in our study).…”

Section: Discussionsupporting

confidence: 81%

Long‐term safety and efficacy of imatinib mesylate (Gleevec®) in elderly patients with chronic phase chronic myelogenous leukemia: Results of the AFR04 study

et al. 2012

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Data from registries suggest that the median age of chronic myelogenous leukemia (CML) patients is 10–15 years older than that of clinical trials. We conducted a prospective phase II study to evaluate imatinib mesylate (IM, 400 mg daily) in newly diagnosed chronic phase CML (CP‐CML) patients. Patients aged 70 years and over diagnosed with CP‐CML within 12 months were eligible. Thirty patients were enrolled from April 2002 to October 2004. Median age was 74.8 years (range, 70–90). Male/female ratio was 1.72. At inclusion, comorbidities were reported in all but one patient, Cumulative Illness Rating Scale for Geriatrics comorbidity mean index was 1.47, and 66% of patients had cardiovascular disease. The median daily IM dose was 392 mg (range, 256–445). IM was interrupted in patients with severe comorbidities. Treatment discontinuation was observed in 36.6% of patients. Cumulative incidence of complete cytogenetic response was 71.4 and 78.5% at 12 and 24 months, respectively. A high level of sustained responses was observed in patients with mild or moderate comorbidities. Seven‐year estimated overall survival was 80.8% (95% CI: 59.0–91.7). Two‐thirds of the patients were still on long‐term therapy at cut‐off, and no patients had died from progression. This trial was registered at http://www.clinicaltrials.gov as # NCT00219765. Am. J. Hematol. 2013. © 2012 Wiley Periodicals, Inc.

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Section: Discussionsupporting

confidence: 81%

Long‐term safety and efficacy of imatinib mesylate (Gleevec®) in elderly patients with chronic phase chronic myelogenous leukemia: Results of the AFR04 study

et al. 2012

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“…[30][31][32][33][34] Right now, with IM therapy in late CP, this negative impact of age has been, at least partially, reappraised. 15,21 However, only limited data are available about the outcome of elderly early CP CML patients treated frontline with IM. 22,35,36 Indeed, an important issue is represented by the allocation of elderly patients to IM treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, few data are available reporting the long-term outcome of older IM-treated CML patients. The 2 largest published series 15,21 analyzed mainly late-CP patients after IFN-␣ failure or intolerance. Rosti et al 21 reported on 284 patients in late CP, of whom 58 (20%) were more than 65 years of age: lower rates of response (hematologic and cytogenetic) in older versus younger patients were observed; however, overall survival (OS), with a median follow-up of 36 months, was similar.…”

Section: Introductionmentioning

confidence: 99%

“…The 2 largest published series 15,21 analyzed mainly late-CP patients after IFN-␣ failure or intolerance. Rosti et al 21 reported on 284 patients in late CP, of whom 58 (20%) were more than 65 years of age: lower rates of response (hematologic and cytogenetic) in older versus younger patients were observed; however, overall survival (OS), with a median follow-up of 36 months, was similar. Of 747 patients treated in a single institution (M. D. Anderson Cancer Center) and reported by Cortes et al, 187 were in early-CP and 49 (26%) of them were more than 60 years old at starting IM: with a short follow-up (median, 16 months), similar rates of complete cytogenetic response (CCyR) and OS were observed between the 2 groups of age.…”

Section: Introductionmentioning

confidence: 99%

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Frontline imatinib treatment of chronic myeloid leukemia: no impact of age on outcome, a survey by the GIMEMA CML Working Party

Gugliotta

Castagnetti

Palandri

et al. 2011

Blood

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The median age of chronic myeloid leukemia (CML) patients is ϳ 60 years, and age is still considered an important prognostic factor, included in Sokal and EURO risk scores. However, few data are available about the long-term outcome of older patients treated with imatinib (IM) frontline. We analyzed the relationship between age and outcome in 559 early chronic-phase CML patients enrolled in 3 prospective clinical trials of Gruppo Italiano Malattie Ematologiche dell'Adulto CML Working Party, treated frontline with IM, with a median follow-up of 60 months. There were 115 older patients (> 65 years; 21%). The complete cytogenetic and major molecular response rates were similar in the 2 age groups. In older patients, event-free survival (55% vs 67%), failurefree survival (78% vs 92%), progressionfree survival (62% vs 78%), and overall survival (75% vs 89%) were significantly inferior (all P < .01) because of a higher proportion of deaths that occurred in complete hematologic response, therefore unrelated to CML progression (15% vs 3%, P < .0001). The outcome was similar once those deaths were censored. These data show that response to IM was not affected by age and that the mortality rate linked to CML is similar in both age groups. This trial was registered at www. clinicaltrials.gov as #NCT00514488 and #NCT00510926. (Blood. 2011;117(21): 5591-5599)

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“…This improvement is especially notable in the younger patient populations, but there is reason to expect that improvement in survival will extend to older populations as further experience in the use of TKIs for CML is accumulated 24,25 and studies delineate the safest and most effective ways to use them in older patients. Relative survival for younger patients with CML who have survived for five years is greater than 90%, suggesting that late progression is becoming a rarer event in CML and that the course of the disease may be significantly delayed.…”

Section: Discussionmentioning

confidence: 99%

Recent trends in long-term survival of patients with chronic myelocytic leukemia: disclosing the impact of advances in therapy on the population level

Brenner¹,

Gondos²,

Pulte³

2008

Haematologica

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Within the past decades, major advances in therapy for chronic myelocytic leukemia, including allogeneic hematopoietic stem cell transplantation, interferon therapy, and, more recently, also therapy with the tyrosine kinase inhibitor imatinib, have entered clinical practice. The impact of these advances on long-term survival on the population level should be disclosed as timely as possible. We estimated trends in age specific 5-and 10-year relative survival of chronic myelocytic leukemia patients in the United States from 1990States from -1992States from to 2002States from -2004. Our analysis is based on records from 8,329 patients aged 15 years or older with a first diagnosis of chronic myelocytic leukemia included in the 1973-2004 data base of the Surveillance, Epidemiology, and End Results Program. Period analysis was used to disclose recent developments with minimum delay. Overall, 5-year relative survival increased from 27 to 49%, and 10-year relative survival increased from 9.5 to 34% between 1990-92 and 2002-04. The increase was most dramatic for younger patients, with 10-year relative survival increasing from 16 to 72% in age group 15-44 years, from 12 to 54% in age group 45-54 years, and from 8 to 34% in age group 55-64 years (p<0.0001 in all cases). Improvements were more modest and not statistically significant, and survival remained at much lower levels among age groups 65-74 and 75+ years. Our analysis discloses a dramatic recent increase in long-term survival of younger patients with chronic myelocytic leukemia which most likely reflects rapid dissemination of advances in therapy on the population level.

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Impact of age on the outcome of patients with chronic myeloid leukemia in late chronic phase: results of a phase II study of the GIMEMA CML Working Party

Cited by 60 publications

References 20 publications

Long‐term safety and efficacy of imatinib mesylate (Gleevec®) in elderly patients with chronic phase chronic myelogenous leukemia: Results of the AFR04 study

Long‐term safety and efficacy of imatinib mesylate (Gleevec®) in elderly patients with chronic phase chronic myelogenous leukemia: Results of the AFR04 study

Frontline imatinib treatment of chronic myeloid leukemia: no impact of age on outcome, a survey by the GIMEMA CML Working Party

Recent trends in long-term survival of patients with chronic myelocytic leukemia: disclosing the impact of advances in therapy on the population level

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