Life Expectancy of Patients With Chronic Myeloid Leukemia Approaches the Life Expectancy of the General Population

Abstract

Purpose A dramatic improvement in the survival of patients with chronic myeloid leukemia (CML) occurred after the introduction of imatinib mesylate, the first tyrosine kinase inhibitor (TKI). We assessed how these changes affected the life expectancy of patients with CML and life-years lost as a result of CML between 1973 and 2013 in Sweden. Materials and Methods Patients recorded as having CML in the Swedish Cancer Registry from 1973 to 2013 were included in the study and followed until death, censorship, or end of follow-up. The life expectancy and loss in expectation of life were predicted from a flexible parametric relative survival model. Results A total of 2,662 patients with CML were diagnosed between 1973 and 2013. Vast improvements in the life expectancy of these patients were seen over the study period; larger improvements were seen in the youngest ages. The great improvements in life expectancy translated into great reductions in the loss in expectation of life. Patients of all ages diagnosed in 2013 will, on average, lose < 3 life-years as a result of CML. Conclusion Imatinib mesylate and new TKIs along with allogeneic stem cell transplantation and other factors have contributed to the life expectancy in patients with CML approaching that of the general population today. This will be an important message to convey to patients to understand the impact of a CML diagnosis on their life. In addition, the increasing prevalence of patients with CML will have a great effect on future health care costs as long as continuous TKI treatment is required.

Tyrosine kinase inhibitor (TKI) therapy for newly-diagnosed patients with chronic myeloid leukemia: focusing on TKI discontinuation due to adverse events – is better always good?

“…The main reasons for treatment discontinuation included AEs, disease progression, and treatment failure [13]. Knowing the fact that no significant difference between different TKIs is observed in terms of OS up-to-date, OS is obviously no longer the best end point for comparing the treatment outcomes, since the life expectancy of patients with CML approaches to that of general population in the era of TKIs [14].…”

De-escalation of tyrosine kinase inhibitor dose in patients with chronic myeloid leukaemia with stable major molecular response (DESTINY): an interim analysis of a non-randomised, phase 2 trial

“…1 However, TKI therapy is not without adverse effects 2 and is expensive 3 . This has led to CML specialists and patients asking whether after a few years of TKI therapy, the disease may be sufficiently suppressed to permit treatment discontinuation.…”

Impact of hospital experience on the quality of tyrosine kinase inhibitor response monitoring and consequence for chronic myeloid leukemia patient survival

“…Although the life expectancy of patients with CML is approaching the life expectancy of the general population, 14 the study herein suggests that a potential survival benefit of 9% over a period of four years can be gained by the optimization of molecular response monitoring in the first year of TKI treatment. Promoting adequate TKI response monitoring has been a priority of the HOVON (Dutch-Belgian Cooperative Trial Group for HematologyOncology) leukemia working group.…”