Impact of comorbidities on overall survival in patients with chronic myeloid leukemia: results of the randomized CML Study IV

Saußele, Susanne; Krauß, Marie-Paloma; Hehlmann, Rüdiger; Lauseker, Michael; Proetel, Ulrike; Kalmanti, Lida; Hanfstein, Benjamin; Fabarius, Alice; Kraemer, Doris; Berdel, Wolfgang E.; Bentz, Martin; Staib, Peter; Wit, Maike de; Wernli, Martin; Zettl, Florian; Hebart, Holger; Hahn, Markus; Heymanns, Jochen; Schmidt‐Wolf, Ingo G.H.; Schmitz, Norbert; Eckart, Michael J.; Gaßmann, W.; Bartholomäus, A.; Pezzutto, Antonio; Leibundgut, Elisabeth Oppliger; Heim, Dominik; Krause, Stefan W.; Burchert, Andreas; Hofmann, Wolf‐Karsten; Hasford, Joerg; Hochhaus, Andreas; Pfirrmann, Markus; Müller, Martin C.

doi:10.1182/blood-2015-01-617993

Cited by 177 publications

(151 citation statements)

References 31 publications

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“…They concluded that the presence of comorbidity is more important than the disease itself in determining the survival of patients. Our findings complement this remarkable data [25] by showing that comorbidity also heavily influence HRQOL of elderly patients. Notably, in our analysis of variance, the presence of comorbidities was by far the most important contributor in determining the subjective general health status scale of the SF-36.…”

Section: Discussionsupporting

confidence: 70%

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The impact of comorbidity on health-related quality of life in elderly patients with chronic myeloid leukemia

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et al. 2015

Ann Hematol

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The primary objective of this study was to investigate whether the presence of comorbidities was associated with a lower health-related quality of life (HRQOL) in elderly patients with chronic myeloid leukemia (CML). A sample of 174 CML patients aged 60 years or above was analyzed. HRQOL was assessed with the Medical Outcomes Study 36-Item ShortForm Health Survey (SF-36). A number of pre-selected sociodemographic and disease-related factors were considered as potential confounding factors for the association between comorbidity and HRQOL. Mean age of the 174 patients analyzed was 70 years (range 60-87 years) and 55 % were male. Overall, 111 patients (64 %) reported at least one comorbidity. Analysis stratified by age group category showed a greater proportion of patients with comorbidities in the older subgroup population (≥70 years) compared to younger patients (60 to 69 years). Differences in HRQOL outcomes between patients with no comorbidity at all and those with two or more comorbid conditions were at least twice the magnitude of a clinically meaningful difference in all the physical and mental health scales of the SF-36. In multivariate analysis, after adjusting for key confounding factors, the following scales were significantly lower in those with comorbidity: general health (p<0.001), bodily pain (p<0.001), physical functioning (p=0.002), and vitality (p=0.002). Assessing comorbidity in elderly patients with CML is important to facilitate identification of those most in need of HRQOL improvements.

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Section: Discussionsupporting

confidence: 70%

“…Saussele and colleagues [25] recently showed that comorbidity at diagnosis was an independent prognostic factor for shorter survival in imatinib-treated CML patients regardless of age. They concluded that the presence of comorbidity is more important than the disease itself in determining the survival of patients.…”

Section: Discussionmentioning

confidence: 99%

The impact of comorbidity on health-related quality of life in elderly patients with chronic myeloid leukemia

Efficace¹,

Rosti

Breccia

et al. 2015

Ann Hematol

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“…CCI is a validated prognostic tool that takes into account 18 disease states of varying severity as well as age [11]. A modified version of CCI (mCCI) in which leukemia was not entered into the model was used [12,13]. Zubrod score and Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) were recorded [14,15].…”

Section: Methodsmentioning

confidence: 99%

“…1 and 2; P value nonsignificant for both comparisons). The 3-year CIR and NRM were 61% [41-76] and 9% [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] for the chemotherapy-only group and 28% and 32% for the transplant group (Table II; Fig. 3; P 5 0.011 for CIR and P 5 0.014 for NRM).…”

Section: Chemotherapy Vs Allogeneic Transplantation In First Remissionmentioning

confidence: 99%

Allogeneic transplantation is not superior to chemotherapy in most patients over 40 years of age with Philadelphia‐negative acute lymphoblastic leukemia in first remission

et al. 2016

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Survival of patients 40 years of age with Philadelphia-negative acute lymphoblastic leukemia (ALL) remains poor with current therapeutic approaches. It is unknown whether allogeneic hematopoietic stem-cell transplantation (HSCT) in first remission confers a survival benefit compared to a chemotherapy-only approach. We retrospectively compared the outcome of patients >40 years treated with HSCT or chemotherapy alone in first remission (n 5 40 in each cohort). Three-year overall survival (OS) and diseasefree survival (DFS) were not significantly different between the chemotherapy-only and HSCT groups (OS, for the transplant group (CIR, P 5 0.011; NRM, P 5 0.014). Allogeneic transplantation for patients 40 years with Ph-negative ALL in first remission is associated with a lower CIR, but this benefit is offset by considerable NRM as compared with chemotherapy-only approach. HSCT may be beneficial in patients with high-risk disease features.

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“…Osimertinib may indeed be a "better" drug by virtue of its improved side effect profile, ability to inhibit a wider range of mutations, and remarkable CNS penetration (14), but even first-line use does not lead to durable, long-term disease control. Unlike the introduction of imatinib for CML and the transition to non-cancer causes of mortality for many of these patients resulting from the durable efficacy of targeted therapies (15), most patients diagnosed today with EGFRm NSCLC still have a greater likelihood of dying from their cancer than from anything else. Targeted therapies in this setting have raised the bar, but there is a still a long way to go.…”

mentioning

confidence: 99%

Raising the bar: the future of EGFR inhibition in non-small lung cancer

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2017

Transl. Lung Cancer Res.

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Impact of comorbidities on overall survival in patients with chronic myeloid leukemia: results of the randomized CML Study IV

Abstract: Key Points There is a strong negative association between comorbidities at diagnosis and overall survival. There is no negative effect of comorbidities on remission rates and progression to advanced phases in CML.

Cited by 177 publications

References 31 publications

The impact of comorbidity on health-related quality of life in elderly patients with chronic myeloid leukemia

The impact of comorbidity on health-related quality of life in elderly patients with chronic myeloid leukemia

Allogeneic transplantation is not superior to chemotherapy in most patients over 40 years of age with Philadelphia‐negative acute lymphoblastic leukemia in first remission

Raising the bar: the future of EGFR inhibition in non-small lung cancer

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