The impact of health care settings on survival time of patients with chronic myeloid leukemia

Lauseker, Michael; Hasford, Joerg; Pfirrmann, Markus; Hehlmann, Rüdiger

doi:10.1182/blood-2013-11-539742

Cited by 25 publications

(16 citation statements)

References 6 publications

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“…54 All patients were treated with first-line imatinib, at an initial dose of 400 mg (76% of patients) or 800 mg (24% of patients). A significant proportion of the patients treated with 800 mg had a high Sokal score, and it was already reported that in these patients the dose of imatinib did not affect significantly the response.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcome of chronic myeloid leukemia patients treated frontline with imatinib

et al. 2015

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For almost 10 years imatinib has been the therapeutic standard of chronic myeloid leukemia. The introduction of other tyrosine kinase inhibitors (TKIs) raised a debate on treatment optimization. The debate is still heated: some studies have protocol restrictions or limited follow-up; in other studies, some relevant data are missing. The aim of this report is to provide a comprehensive, long-term, intention-to-treat, analysis of 559 newly diagnosed, chronic-phase, patients treated frontline with imatinib. With a minimum follow-up of 66 months, 65% of patients were still on imatinib, 19% were on alternative treatment, 12% died and 4% were lost to follow-up. The prognostic value of BCR-ABL1 ratio at 3 months (⩽10% in 81% of patients) was confirmed. The prognostic value of complete cytogenetic response and major molecular response at 1 year was confirmed. The 6-year overall survival was 89%, but as 50% of deaths occurred in remission, the 6-year cumulative incidence of leukemia-related death was 5%. The long-term outcome of first-line imatinib was excellent, also because of second-line treatment with other TKIs, but all responses and outcomes were inferior in high-risk patients, suggesting that to optimize treatment results, a specific risk-adapted treatment is needed for such patients.

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Section: Discussionmentioning

confidence: 99%

Long-term outcome of chronic myeloid leukemia patients treated frontline with imatinib

et al. 2015

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“…Previous publications suggested that centralised care of patients with CML is important for achieving results comparable with those of clinical trials [35,44]. More recently, Lauseker et al, analysing the outcome of 1491 patients included in the German CML Study IV, observed a survival advantage for patients treated initially at a teaching hospital compared to those treated in municipal hospitals and by officebased physicians, respectively [45].…”

Section: Survival Rates and Non-disease-related Prognostic Factorsmentioning

confidence: 99%

Epidemiology of chronic myeloid leukaemia: an update

2015

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National and regional population-based registries are, provided diagnostic accuracy and full coverage of the target population, indispensible tools for epidemiological research. Chronic myeloid leukaemia (CML) registries with more comprehensive reporting may also provide complementary data on treatment outcome to those obtained from clinical trials. Reports from several European CML registries consistently show a crude annual incidence of 0.7-1.0/100,000, a median age at diagnosis of 57-60 years and a male/female ratio of 1.2-1.7. The incidence of CML has been stable over time. Worldwide, variations in the reported incidence of CML may be due to methodological issues, but a true difference between different geographical areas and/or ethnical subgroups cannot be excluded. The prevalence of CML is not well known but has been estimated to be 10-12/100,000 inhabitants with a steady increase due to the dramatic improvement in survival of these patients. In recent population-based studies, CML patients have an overall survival that is comparable to that shown in large clinical trials, though relative survival in patients >70 years is still decreased. The importance of socio-economic factors and health-care setting for outcome and the possible increased risk of secondary cancer in CML are areas of ongoing research.

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“…For example, Lauseker et al analyzed the survival of CML patients in different settings, showing superior survival for patients treated in teaching hospitals [24]. This is of special Fig.…”

Section: Discussionmentioning

confidence: 99%

Health care setting and severity, symptom burden, and complications in patients with Philadelphia-negative myeloproliferative neoplasms (MPN): a comparison between university hospitals, community hospitals, and office-based physicians

et al. 2016

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Philadelphia-negative myeloproliferative neoplasms (MPN) comprise a heterogeneous group of chronic hematological malignancies with significant variations in clinical characteristics. Due to the long survival and the feasibility of oral or subcutaneous therapy, these patients are frequently treated outside of larger academic centers. This analysis was performed to elucidate differences in MPN patients in three different health care settings: university hospitals (UH), community hospitals (CH), and office-based physicians (OBP). The MPN registry of the Study Alliance Leukemia is a non-interventional prospective study including adult patients with an MPN according to WHO criteria (2008). For statistical analysis, descriptive methods and tests for significant differences were used. Besides a different distribution of MPN subtypes between the settings, patients contributed by UH showed an impaired medical condition, a higher comorbidity burden, and more vascular complications. In the risk group analyses, the majority of polycythemia vera (PV) and essential thrombocythemia (ET) patients from UH were classified into the high-risk category due to previous vascular events, while for PV and ET patients in the CH and OBP settings, age was the major parameter for a high-risk categorization. Regarding MPN-directed therapy, PV patients from the UH setting were more likely to receive ruxolitinib within the framework of a clinical trial. In summary, the characteristics and management of patients differed significantly between the three health care settings with a higher burden of vascular events and comorbidities in patients contributed by UH. These differences need to be taken into account for further analyses and design of clinical trials.

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The impact of health care settings on survival time of patients with chronic myeloid leukemia

Abstract: Key Points CML patients enjoyed superior survival chances when treated in THs. Treatment centers having less experience with CML patients did not affect the patient’s survival chances.

Cited by 25 publications

References 6 publications

Long-term outcome of chronic myeloid leukemia patients treated frontline with imatinib

Long-term outcome of chronic myeloid leukemia patients treated frontline with imatinib

Epidemiology of chronic myeloid leukaemia: an update

Health care setting and severity, symptom burden, and complications in patients with Philadelphia-negative myeloproliferative neoplasms (MPN): a comparison between university hospitals, community hospitals, and office-based physicians

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