Quality of Life and Symptom Burden With First- and Second-generation Tyrosine Kinase Inhibitors in Patients With Chronic-phase Chronic Myeloid Leukemia

Bostan, Hayri; Toptaş, Tayfur; Tanrıkulu, Funda Pepedil; Kut, K.; Arıkan, Fatma; Yilmaz, Fergun; Atagündüz, Işık Kaygusuz; Fıratlı-Tuğlular, Tulin

doi:10.1016/j.clml.2020.08.009

Cited by 6 publications

(4 citation statements)

References 23 publications

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“…Fatigue, gastrointestinal reactions, edema, rash, and skeletal muscle soreness were frequent symptoms among CML patients. Similarly, fatigue was the most common symptom of patients with CML taking imatinib and second‐generation TKI 28 . In a propensity‐matched case–control study assessing patients' QoL, dasatinib was found to have a significantly lower score for impact on daily life compared to imatinib 29 .…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, fatigue was the most common symptom of patients with CML taking imatinib and second‐generation TKI. 28 In a propensity‐matched case–control study assessing patients' QoL, dasatinib was found to have a significantly lower score for impact on daily life compared to imatinib. 29 In a subgroup analysis of the ENESTnd trial, nilotinib 300 mg BID had a lower incidence for general disorders than imatinib.…”

Section: Discussionmentioning

confidence: 99%

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Quality‐of‐life, mental health, and perspective on TKI dose reduction as a prelude to discontinuation in chronic phase chronic myeloid leukemia

Chen

Yang

et al. 2023

Cancer Medicine

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BackgroundTreatment‐free remission (TFR) has become the main target for chronic myeloid leukemia (CML). Tyrosine kinase inhibitors (TKI) dose optimization is crucial in managing adverse events, and improving adherence in clinical practice. In persons achieving a deep molecular response (DMR), some data suggest TKI dose reduction before discontinuation does not change success rate of achieving TFR, but this is controversial. However, data on quality‐of‐life (QoL) and mental health in CML patients with full‐dose TKI, low‐dose TKI, and TKI discontinuation are limited. Moreover, recent evidence indicating the feasibility of TKI dose reduction and discontinuation after dose reduction, which may change CML patients' perspectives on TKI discontinuation.MethodsWe conducted a cross‐sectional study using online questionnaires to explore the QoL, mental health in patients with diverse TKI dose, and perspective on TKI dose reduction as a prelude to discontinuation.Results1450 responses were included in the analysis. 44.3% of respondents reported a moderate‐to‐severe impact of TKI treatment on their QoL. 17% of respondents had moderate‐to‐severe anxiety. 24.4% of respondents had moderate‐to‐severe depression. In 1326 patients who had not discontinued their medication, 1055 (79.6%) patients reported they would try TKI discontinuation because of concerns over side effects of long‐term medication (67.9%), financial burden (68.7%), poor QoL (77.9%), pregnancy needs (11.6%), anxiety and depression while taking TKI (20.8%), inconvenience of TKI treatment (22.2%). 613 of 817 (75.0%) patients on full‐dose TKI therapy indicated they preferred trying a dose reduction before discontinuing TKI therapy after dose reduction compared with 31 (3.8%) preferring no dose reduction before stopping.ConclusionsTKI dose reduction showed a significant improvement of patients' QoL and mental health, comparable to the effect of TKI discontinuation. Most patients indicated they preferred dose reduction before stopping TKI therapy. In clinical practice, TKI dose reduction can be considered as a bridge from full‐dose treatment to discontinuation.Our results showed that tyrosine kinase inhibitors (TKI) dose reduction showed a significant improvement of patients' quality‐of‐life and mental health, comparable to the effect of TKI discontinuation. Most patients desire to discontinue TKI in the future. TKI discontinuation after dose reduction is more acceptable compared to discontinuing it directly. In clinical practice, TKI dose reduction can be considered as a bridge from full‐dose treatment to discontinuation. Please do not hesitate to contact me in case further clarification is needed with this submission.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Quality‐of‐life, mental health, and perspective on TKI dose reduction as a prelude to discontinuation in chronic phase chronic myeloid leukemia

Chen

Yang

et al. 2023

Cancer Medicine

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“…We cannot conclude that this was related to the psychosocial character of the AYA population. A study assessing the QOL and symptom burden of patients receiving TKIs reported that there were no significant differences between the groups in terms of the effects on their daily life activities [ 38 ]. Combined with QOL issues, assessing the psychosocial burden of AYA patients may contribute to better management.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of adolescents and young adults with chronic-phase chronic myeloid leukaemia treated with tyrosine kinase inhibitors

et al. 2022

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Introduction Few studies have reported the outcomes of adolescents and young adults (AYAs) with chronic-phase chronic myeloid leukaemia (CML-CP) on tyrosine kinase inhibitors (TKIs). Materials and methods We retrospectively analysed the clinical features, treatment response, and long-term outcomes of 42 AYA patients, in comparison to older patients. The initial therapies of AYA patients between 2001 and 2016 included imatinib ( n = 24), dasatinib ( n = 13) and nilotinib ( n = 5). Results In AYA patients, the peripheral blood (PB) white blood cell count and percentage of blasts at the diagnosis were significantly higher, haemoglobin levels were lower and the spleen size was larger. The major molecular response (MMR), event-free survival (EFS) and overall survival (OS) rates were comparable. A sub-analysis comparing imatinib to second-generation TKIs as the initial therapy also showed that their prognosis was comparable. Discussion In conclusion, the tumour burden at the diagnosis of CML-CP is higher in AYA patients; however, their prognosis was not worse in comparison to older patients treated with TKIs. KEY MESSAGES Few studies have reported the outcomes of adolescents and young adults (AYAs) with chronic-phase chronic myeloid leukaemia (CML-CP) on tyrosine kinase inhibitors (TKIs). This study showed the tumour burden at the diagnosis of CML-CP is higher in AYA pa tients; however, their prognosis was not worse in comparison to older patients treated with TKIs. Understanding the biological and non-biological features of AYA patients with CML-CP on TKI therapy is essential for better management and to improve the outcomes.

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“…Fatigue is one of the long-term effects of TKI therapy, particularly with imatinib or dasatinib. However, the underlying mechanism remains unclear [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Relationship between Carnitine Deficiency and Tyrosine Kinase Inhibitor Use in Patients with Chronic Myeloid Leukemia

et al. 2021

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Background: Some chemotherapeutic agents cause carnitine deficiency, which confers general fatigue; however, there is no study on carnitine deficiency in patients with chronic myeloid leukemia (CML) during tyrosine kinase inhibitor (TKI) therapy. Objective: This study investigated carnitine concentrations in patients with CML treated with TKIs. Method: This study included patients with well-controlled CML. Total carnitine and free carnitine concentrations were evaluated using the enzyme cycling method. The Brief Fatigue Inventory (BFI) and Cancer Fatigue Scale (CFS) were used to assess general fatigue developed during TKI therapy. Results: Fifty-five patients on TKIs were included; 12 (21.8%) had low free carnitine concentrations. Free carnitine concentrations were higher in men than in women. Younger age was closely associated with lower free carnitine concentrations. TKI type, TKI dose, treatment response, or therapy duration were not associated with free carnitine concentrations. None of the scores (the global fatigue score with the BFI and CFS score) correlated with carnitine concentrations. Concentrations of free carnitine in the treatment-free remission group were slightly higher than those in the TKI group, with only 9.1% having a low concentration of free carnitine. Conclusion: Carnitine deficiency is probably not a major cause of general fatigue, but may occur in patients with CML receiving TKIs.

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Quality of Life and Symptom Burden With First- and Second-generation Tyrosine Kinase Inhibitors in Patients With Chronic-phase Chronic Myeloid Leukemia

Cited by 6 publications

References 23 publications

Quality‐of‐life, mental health, and perspective on TKI dose reduction as a prelude to discontinuation in chronic phase chronic myeloid leukemia

Quality‐of‐life, mental health, and perspective on TKI dose reduction as a prelude to discontinuation in chronic phase chronic myeloid leukemia

Outcomes of adolescents and young adults with chronic-phase chronic myeloid leukaemia treated with tyrosine kinase inhibitors

Relationship between Carnitine Deficiency and Tyrosine Kinase Inhibitor Use in Patients with Chronic Myeloid Leukemia

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