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Stempel JM, Shallis RM, Wong R, Podoltsev NA. Challenges in management of older patients with chronic myeloid leukemia. Leuk Lymphoma 2024; 65:1219-1232. [PMID: 38652861 DOI: 10.1080/10428194.2024.2342559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/22/2024] [Accepted: 04/07/2024] [Indexed: 04/25/2024]
Abstract
Tyrosine kinase inhibitors (TKIs) have significantly improved the survival of patients with chronic myeloid leukemia (CML), however, older patients are often underrepresented in pivotal trials. Approximately 20% of older adults never start treatment and face significant barriers to accomplish favorable outcomes. The treatment goal is to improve survival, prevent progression, and preserve quality of life. This is achieved through optimizing TKI doses and employing discontinuation strategies to attain treatment-free remission (TFR), a goal increasingly pursued by older patients. Imatinib may be favored as the front-line option for older individuals due to its side effect profile and cost. Bosutinib's favorable cardiovascular tolerability makes it a suitable second-line agent, but lower-dose dasatinib may likewise be an attractive option. The prevalence of comorbidities can preclude the use of second generation TKIs in some older patients. Optimal care for older patients with CML centers on personalized treatment, close monitoring, and proactive support.
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Affiliation(s)
- Jessica M Stempel
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT, USA
| | - Rory M Shallis
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT, USA
| | - Rong Wong
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Nikolai A Podoltsev
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT, USA
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Imamura M, Nakamura Y, Hidaka D, Ogasawara R, Okada K, Sugita J, Ota S. Long-term follow-up of efficacy and safety in elderly patients with chronic myeloid leukemia treated with intermittent low dose dasatinib therapy. Leuk Res Rep 2024; 21:100452. [PMID: 38444525 PMCID: PMC10912670 DOI: 10.1016/j.lrr.2024.100452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/22/2024] [Indexed: 03/07/2024] Open
Abstract
Intermittent low dose dasatinib therapy brought about a beneficial effect in elderly patients with chronic-phase chronic myeloid leukemia (CML-CP) without inducing severe adverse events (AEs). An 85-year-old male patient, who received twice-weekly, thrice-weekly, or four-times-weekly administration of 20 mg/day dasatinib after once-weekly administration, achieved a major molecular response two years after the start of dasatinib treatment and later sometimes achieved a deep molecular response, maintaining the efficacy for 11 years. The mean daily dose ranged from 5.7 mg to 11.4 mg. Furthermore, a 79-year-old male patient, who received thrice-weekly or every other day administration of 20 mg/day dasatinib after once-weekly administration, achieved a deep molecular response at four and half years after the start of dasatinib treatment. The mean daily dose is 8.6 mg. Intermittent low dose dasatinib therapy appears to be feasible in elderly patients with CML-CP. The goal of treatment in elderly patients with CML-CP appears to be different from that in younger patients, since they often suffer from serious AEs in the case of standard dose tyrosine kinase inhibitor therapy, followed by the dose reduction or cessation of treatment.
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Affiliation(s)
- Masahiro Imamura
- Department of Hematology, Sapporo Hokuyu Hospital, 5-1, 6 Jyo 5 Chome, Higashi-sapporo, Shiroishi-ku, Sapporo, 003-0006, Japan
| | - Yusuke Nakamura
- Department of Pharmacy, Sapporo Hokuyu Hospital, 5-1, 6 Jyo 5 Chome, Higashi-sapporo, Shiroishi-ku, Sapporo, 003-0006, Japan
| | - Daisuke Hidaka
- Department of Hematology, Sapporo Hokuyu Hospital, 5-1, 6 Jyo 5 Chome, Higashi-sapporo, Shiroishi-ku, Sapporo, 003-0006, Japan
| | - Reiki Ogasawara
- Department of Hematology, Sapporo Hokuyu Hospital, 5-1, 6 Jyo 5 Chome, Higashi-sapporo, Shiroishi-ku, Sapporo, 003-0006, Japan
| | - Kohei Okada
- Department of Hematology, Sapporo Hokuyu Hospital, 5-1, 6 Jyo 5 Chome, Higashi-sapporo, Shiroishi-ku, Sapporo, 003-0006, Japan
| | - Junichi Sugita
- Department of Hematology, Sapporo Hokuyu Hospital, 5-1, 6 Jyo 5 Chome, Higashi-sapporo, Shiroishi-ku, Sapporo, 003-0006, Japan
| | - Shuichi Ota
- Department of Hematology, Sapporo Hokuyu Hospital, 5-1, 6 Jyo 5 Chome, Higashi-sapporo, Shiroishi-ku, Sapporo, 003-0006, Japan
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Scholz S, Berns I, Winkler C. Listen to the patients! Identifying CML patients' needs analyzing patient-generated content with AI-driven methodologies. Front Digit Health 2023; 5:1243215. [PMID: 38116100 PMCID: PMC10729659 DOI: 10.3389/fdgth.2023.1243215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
Background Various patient support programs exist to provide successful therapy options for patients. Pharmaceutical companies are increasingly recognizing the importance of actively supporting patients in their long-term treatment. In order to effectively assist patients, it is crucial to understand their current needs by taking a look at the patients' opinions. Objective This study focuses specifically on chronic myeloid leukemia (CML) and aims to determine if the current patient engagement offerings from pharmaceutical companies adequately address the needs of CML patients. To achieve this, the study uses content generated by CML patients to assess the patient engagement strategies of selected pharmaceutical companies, explore the relevance of medication, their products, and services, and analyze key concerns from the perspective of the patients. Methods To address the research questions, various methodologies were employed. Initially, desk research was conducted to identify relevant pharmaceutical companies and internet forums related to CML. Subsequently, content generated by patients was acquired and AI-driven techniques such as topic modeling and topic evolution analyses were used to examine this user-generated content (UGC) within the identified public forums. This involved analyzing topic models and tracking topic changes over time. Results The desk research revealed that pharmaceutical companies primarily offer information about the disease and available treatment options. The UGC analysis confirmed the significant role played by the industry in supporting CML patients. Key areas of interest for patients include the disease itself, potential treatment methods and associated side effects, dosage of active substances, and the possibility of switching therapies due to treatment failure or resistance. Stem cell transplantation was also discussed. Conclusions Overall, the pharmaceutical industry adequately addresses the needs of CML patients. However, there is room for improvement in educating patients about treatment options, drugs, and their side effects. Psychological support should not be neglected. Since CML patients frequently engage with clinical trial outcomes, there is potential for increased patient involvement in such trials. Further research in this area is recommended.
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Affiliation(s)
- Stefanie Scholz
- Data Science in Social Economy, SRH Wilhelm Loehe University of Applied Sciences, Fuerth, Germany
| | - Isabell Berns
- Health Economics, University of Bayreuth, Bayreuth, Germany
| | - Christian Winkler
- AI-driven User Experience Optimization, Nuremberg Institute of Technology, University of Applied Sciences, Nuremberg, Germany
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He S, Zhao J, Bian J, Zhao Y, Li Y, Guo N, Hu L, Liu B, Shao Q, He H, Huang L, Jiang Q. Population Pharmacokinetics and Pharmacogenetics Analyses of Dasatinib in Chinese Patients with Chronic Myeloid Leukemia. Pharm Res 2023; 40:2413-2422. [PMID: 37726405 DOI: 10.1007/s11095-023-03603-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
AIMS Dasatinib, a second-generation tyrosine kinase inhibitor of BCR-ABL 1, used for first-line treatment of Philadelphia chromosome-positive chronic myeloid leukemia (CML), exhibits high pharmacokinetic (PK) variability. However, its PK data in Chinese patients with CML remains rarely reported to date. Thus, we developed a population pharmacokinetic (PPK) model of dasatinib in Chinese patients and identified the covariate that could explain the individual variability of PK for optimal individual administration. METHODS PPK modeling for dasatinib was performed based on 754 plasma concentrations obtained from 140 CML patients and analysis of various genetic and physicochemical parameters. Modeling was performed with nonlinear mixed-effects (NLME) using Phoenix NLME. The finally developed model was evaluated using internal and external validation. Monte Carlo simulations were used to predict drug exposures at a steady state for various dosages. RESULTS The PK of dasatinib were well described by a two-compartment with a log-additive residual error model. Patients in the current study had a relatively low estimate of CL/F (126 L/h). A significant association was found between the covariate of age and CL/F of dasatinib, which was incorporated into the final model. None of the genetic factors was confirmed as a significant covariate for dasatinib. The results of external validation with 140 samples from 36 patients were acceptable. Simulation results showed significantly higher exposures in elderly patients. CONCLUSIONS This study's findings suggested that low-dose dasatinib would be better suited for Chinese patients, and the dosage can be appropriately reduced according to the increase of age, especially for the elderly.
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Affiliation(s)
- Shiyu He
- Department of Pharmacy, Peking University People's Hospital, No. 11 Xizhimen South StreetXicheng District, Beijing, 100044, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Jinxia Zhao
- Department of Pharmacy, Peking University People's Hospital, No. 11 Xizhimen South StreetXicheng District, Beijing, 100044, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Jialu Bian
- Department of Pharmacy, Peking University People's Hospital, No. 11 Xizhimen South StreetXicheng District, Beijing, 100044, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Yinyu Zhao
- Department of Pharmacy, Peking University People's Hospital, No. 11 Xizhimen South StreetXicheng District, Beijing, 100044, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Yuanyuan Li
- Department of Pharmacy, Peking University People's Hospital, No. 11 Xizhimen South StreetXicheng District, Beijing, 100044, China
| | - Nan Guo
- Department of Pharmacy, Peking University People's Hospital, No. 11 Xizhimen South StreetXicheng District, Beijing, 100044, China
| | - Lei Hu
- Department of Pharmacy, Peking University People's Hospital, No. 11 Xizhimen South StreetXicheng District, Beijing, 100044, China
| | - Boyu Liu
- Department of Pharmacy, Peking University People's Hospital, No. 11 Xizhimen South StreetXicheng District, Beijing, 100044, China
| | - Qianhang Shao
- Department of Pharmacy, Peking University People's Hospital, No. 11 Xizhimen South StreetXicheng District, Beijing, 100044, China
| | - Huan He
- Department of Pharmacy, Beijing Children's Hospital of Capital Medical University, Beijing, China
| | - Lin Huang
- Department of Pharmacy, Peking University People's Hospital, No. 11 Xizhimen South StreetXicheng District, Beijing, 100044, China.
| | - Qian Jiang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, No. 11 Xizhimen South StreetXicheng District, Beijing, 100044, China.
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Freydman J, Staron A, Hughes D, Sloan JM. Successful dasatinib therapy in newly diagnosed chronic myeloid leukemia in the setting of short bowel syndrome. J Oncol Pharm Pract 2023; 29:1489-1493. [PMID: 37157792 DOI: 10.1177/10781552231173441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
INTRODUCTION There is limited guidance on the selection of tyrosine kinase inhibitors (TKIs) in patients with short bowel syndrome (SBS). Concerns regarding absorption, toxicity profiles, and drug interactions should be considered when selecting optimal TKI therapy. CASE REPORT A 57-year-old male with SBS was newly diagnosed with chronic myeloid leukemia (CML). A careful review of his surgical history, comorbidities, and concurrent medications led to a treatment decision to initiate dasatinib at 100 mg once daily. MANAGEMENT AND OUTCOME After initiation of therapy, the patient achieved a complete hematological response after two weeks and an early major molecular response on a three-month assessment. The therapy was tolerated well with no identified adverse effects. DISCUSSION Clinical rationale for selecting dasatinib in patients with SBS includes supporting literature regarding its pharmacokinetic absorption characteristics, its efficacy with lower doses in newly diagnosed patients with CML, and its side effect profile in comparison to other second-generation TKIs. The case discussed provides an example of successful therapy in a patient with SBS undergoing treatment for CML.
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Affiliation(s)
- Jessica Freydman
- Section of Hematology and Medical Oncology, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Andrew Staron
- Section of Hematology and Medical Oncology, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - David Hughes
- Section of Hematology and Medical Oncology, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - John M Sloan
- Section of Hematology and Medical Oncology, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
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Lucero JA, Lipton JH. A Pragmatic Approach to Managing Long-Term Adverse Effects in Chronic Myeloid Leukemia Treatment. Curr Hematol Malig Rep 2023:10.1007/s11899-023-00698-4. [PMID: 37191911 DOI: 10.1007/s11899-023-00698-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE OF REVIEW Long-term outcomes have significantly improved with treatment of chronic myeloid leukemia. With proper treatment, most patients will achieve similar survival rates compared to an age-matched population. Treatment-free remission is not attainable for over half of patients and chronic treatment carries with it unique challenges. We provide a pragmatic approach to the monitoring and management of chronic adverse effects (AEs). RECENT FINDINGS In the presence of severe or intolerable AEs, switching tyrosine kinase inhibitors (TKIs) is reasonable but is not without risk. Dose reductions can be attempted when response is stable to reduce AE intensity. More frequent molecular monitoring with any change is essential. Treatment strategies must adapt to the personalized treatment goal of each patient. Long-term survival remains good even when response is less than a complete molecular response. Consider risks of new AEs when changing therapy and evaluate for dose reductions when appropriate.
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Affiliation(s)
- Josephine Anne Lucero
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, ON, M5G2M9, Canada.
| | - Jeffrey H Lipton
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, ON, M5G2M9, Canada
- Division of Hematology, University of Toronto, Toronto, Canada
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Tokuhira M, Kimura Y, Tabayashi T, Watanabe N, Tsuchiya S, Takaku T, Iriyama N, Sato E, Nakazato T, Mitsumori T, Ishikawa M, Fujita H, Kizaki M, Ando M, Hatta Y, Iwanaga E, Kawaguchi T. Clinical management of second-generation tyrosine kinase inhibitor therapy in patients with newly diagnosed chronic myeloid leukemia in the chronic phase, focusing on age and dose effects. Int J Hematol 2023:10.1007/s12185-023-03606-x. [PMID: 37129800 DOI: 10.1007/s12185-023-03606-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 05/03/2023]
Abstract
ABL1-tyrosine kinase inhibitors (TKIs) are an established treatment choice for patients with chronic myeloid leukemia in the chronic phase (CML-CP). However, effects of TKI dose modification have not been well investigated. In this study, we retrospectively analyzed 178 patients with newly diagnosed CML-CP who were treated with dasatinib or nilotinib, focusing on age and dose effects. Efficacy as measured by cumulative major molecular response (MMR) and molecular response 4.5 rates did not differ significantly between the younger group and elderly group. Elderly patients who started nilotinib at a reduced dose had similar or better efficacy outcomes (including cumulative MMR and continuation ratios) than other groups, and elderly patients who started dasatinib at a reduced dose had the lowest MMR ratio and longest MMR duration. Effects of dose modification based on age and TKI selection can be attributed to flexible management of TKI therapy in real-world practice, but further studies are required to validate the findings of this study.
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Affiliation(s)
- Michihide Tokuhira
- Department of Hematology, Japan Community Health Care Organization Saitama Medical Center, Saitama, 330-0074, Japan.
| | - Yuta Kimura
- Department of Hematology, Japan Community Health Care Organization Saitama Medical Center, Saitama, 330-0074, Japan
| | - Takayuki Tabayashi
- Department of Hematology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Naoki Watanabe
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Shun Tsuchiya
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Tomoiku Takaku
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Noriyoshi Iriyama
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Eriko Sato
- Department of Hematology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Tomonori Nakazato
- Department of Hematology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Toru Mitsumori
- Department of Hematology, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Maho Ishikawa
- Department of Hemato-Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Hiroyuki Fujita
- Department of Hematology, Saiseikai Yokohama Nanbu Hospital, Yokohama, Japan
| | - Masahiro Kizaki
- Department of Hematology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Miki Ando
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yoshihiro Hatta
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Eisaku Iwanaga
- Department of Hematology and Infectious Diseases, Kumamoto University Hospital, Kumamoto, Japan
| | - Tatsuya Kawaguchi
- Department of Hematology and Infectious Diseases, Kumamoto University Hospital, Kumamoto, Japan
- Department of Medical Technology, Faculty of Health Sciences, Kumamoto Health Science University, Kumamoto, Japan
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Luciano L, Latagliata R, Gugliotta G, Annunziata M, Tiribelli M, Martino B, Sica A, Esposito MR, Bocchia M, Galimberti S, Sorà F, Albano F, Palmieri R, Pregno P, Dragani M, Iovine M, Sica S, Iurlo A, Castagnetti F, Rosti G, Breccia M. Efficacy and safety of nilotinib as frontline treatment in elderly (> 65 years) chronic myeloid leukemia patients outside clinical trials. Ann Hematol 2023; 102:1375-1382. [PMID: 37079069 PMCID: PMC10182159 DOI: 10.1007/s00277-023-05159-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/04/2023] [Indexed: 04/21/2023]
Abstract
Here, we report real-world evidence on the safety and efficacy of nilotinib as a first-line treatment in elderly patients with chronic phase CML, treated in 18 Italian centers. Sixty patients aged > 65 years (median age 72 years (65-84)) were reported: 13 patients were older than 75 years. Comorbidities were recorded at baseline in 56/60 patients. At 3 months of treatment, all patients obtained complete hematological response (CHR), 43 (71.6%) an early molecular response (EMR), while 47 (78%) reached a complete cytogenetic response (CCyR). At last follow-up, 63.4% of patients still had a deep molecular response (MR4 or better), 21.6% reached MR3 as best response and 11.6% persisted without MR. Most patients (85%) started the treatment at the standard dose (300 mg BID), maintained at 3 months in 80% of patients and at 6 months in 89% of them. At the last median follow-up of 46.3 months, 15 patients discontinued definitively the treatment (8 due to side effects, 4 died for unrelated CML causes, 1 for failure, 2 were lost to follow-up). One patient entered in treatment-free remission. As to safety, 6 patients (10%) experienced cardiovascular events after a median time of 20.9 months from the start. Our data showed that nilotinib could be, as first-line treatment, effective and relatively safe even in elderly CML patients. In this setting, more data in the long term are needed about possible dose reduction to improve the tolerability, while maintaining the optimal molecular response.
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Affiliation(s)
- Luigia Luciano
- Hematology Unit, Federico II" University of Naples, Naples, Italy.
| | - Roberto Latagliata
- Department of Cellular Biotechnologies and Hematology, University "La Sapienza" of Rome, Rome, Italy
| | - Gabriele Gugliotta
- Institute of Hematology "L. and A. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine, "S. Orsola-Malpighi" University Hospital, University of Bologna, Bologna, Italy
| | | | - Mario Tiribelli
- Division of Hematology and BMT, Azienda Ospedaliero - Universitaria Di Udine, Udine, Italy
| | - Bruno Martino
- Hematology Unit, Bianchi Melacrino Morelli Hospital, Reggio Calabria, Italy
| | - Antonello Sica
- Hematologyunit, "L Vanvitelli" University of Campania, Naples, Italy
| | | | - Monica Bocchia
- Hematology Unit, Azienda Ospedaliera Universitaria Senese and University of Siena, Siena, Italy
| | - Sara Galimberti
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Federica Sorà
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, A. Gemelli, IRCCS University Hospital Foundation, Rome, Italy
| | - Francesco Albano
- Hematology and Transplants Unit, University of Bari, Bari, Italy
| | | | - Patrizia Pregno
- Hematology Unit, Azienda Ospedaliero Universitaria Città Della Salute E Della Scienza, Turin, Italy
| | - Matteo Dragani
- Hematology, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Maria Iovine
- Hematology Unit, AO "S. Anna E S. Sebastiano", Caserta, Italy
| | - Simona Sica
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, A. Gemelli, IRCCS University Hospital Foundation, Rome, Italy
| | - Alessandra Iurlo
- Oncohematology Division, IRCCS Ca' Granda - Maggiore Policlinico Hospital Foundation, University of Milan, Milan, Italy
| | - Fausto Castagnetti
- Institute of Hematology "L. and A. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine, "S. Orsola-Malpighi" University Hospital, University of Bologna, Bologna, Italy
| | - Gianantonio Rosti
- Institute of Hematology "L. and A. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine, "S. Orsola-Malpighi" University Hospital, University of Bologna, Bologna, Italy
| | - Massimo Breccia
- Department of Cellular Biotechnologies and Hematology, University "La Sapienza" of Rome, Rome, Italy
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9
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Is higher lymphocyte count a potential strategy for preventing chronic kidney disease in patients receiving long-term dasatinib treatment? J Pharm Health Care Sci 2023; 9:4. [PMID: 36691104 PMCID: PMC9872443 DOI: 10.1186/s40780-022-00270-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/23/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Dasatinib, which is used to treat treating chronic myeloid leukemia, induces increases in blood lymphocytes during the treatment. In addition, neutrophil-lymphocyte count ratio (NLR) is associated with the related to development of chronic kidney disease (CKD). However, it has not been reported whether development of CKD during long-term dasatinib treatment is related to lymphocyte count or NLR. This study aimed to reveal the relationship between CKD and lymphocyte count or NLR during long-term dasatinib treatment. METHODS A retrospective study was conducted in patients treated with dasatinib for 6 months or longer. Risk factors for CKD development were explored using multivariate analysis. Changes in maximal lymphocyte count and NLR over time were examined separately. RESULTS A total of 33 patients in CKD group (n = 8) and No CKD group (n = 25) who received dasatinib were enrolled. In univariate analysis, significant differences between the groups were observed in maximal lymphocyte count, lymphocytosis, age, and estimated glomerular filtration rate at baseline. As the factor independently associated with the development of CKD, maximal lymphocyte count (odds ratio 0.999, 95% confidence interval: 0.999-1.000, p = 0.033) was identified. In this analysis, age had borderline significance (odds ratio 1.073, 95% CI: 0.999-1.153, p = 0.054)]. After 6 months of dasatinib therapy, lymphocyte count was significantly lower in CKD group [median (range), 2184 (878‒3444)/μL] than in the No CKD group [3501 (966‒7888)/μL] (p = 0.020). However, no significant difference in lymphocyte count was observed between the groups at the last follow-up. During the study period, the median NLR in the No CKD group fluctuated between 1.11 and 1.42, and median NLR in CKD group was increased from 1.13 to 2.24 between after 6 months of dasatinib therapy and the last follow-up. CONCLUSIONS The development of CKD during dasatinib therapy was associated with lower maximal lymphocyte counts. In contrast, the higher levels of lymphocytes induced during dasatinib treatment may prevent CKD progression.
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10
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Adverse Reaction Profiles Related to Gastrointestinal Bleeding Events Associated with BCR-ABL Tyrosine Kinase Inhibitors. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58101495. [PMID: 36295654 PMCID: PMC9609656 DOI: 10.3390/medicina58101495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/12/2022] [Accepted: 10/17/2022] [Indexed: 12/04/2022]
Abstract
Background and Objectives: The aim of this study is to investigate the characteristics of gastrointestinal bleeding events associated with BCR-ABL tyrosine kinase inhibitor (TKI) treatment, using the reporting odds ratio (ROR) of the adverse event reports submitted to the Japanese Adverse Drug Event Report database between 2004 and 2020, and to examine the number of reported TKI-related gastrointestinal bleeding cases according to sex and age, as well as the actual number of TKI prescriptions issued in Japan. Materials and Methods: The RORs and 95% confidence intervals (CIs) of gastrointestinal bleeding events related to TKIs were calculated using the data of the 595,121 included cases. Results: Significant gastrointestinal bleeding events were detected for dasatinib (crude ROR: 4.47, 95% CI: 3.77-5.28) and imatinib (crude ROR: 1.22, 95% CI: 1.01-1.46). In multiple logistic regression analyses, significant gastrointestinal bleeding events were detected for dasatinib (adjusted ROR: 8.02, 95% CI: 5.75-10.2), imatinib (adjusted ROR: 1.81, 95% CI: 1.2-2.72), age (≥60 years, adjusted ROR: 2.22, 95% CI: 2.1-2.36), reporting year (adjusted ROR: 1.04, 95% CI: 1.04-1.05), and male sex (adjusted ROR: 1.47, 95% CI: 1.37-1.57). Interaction analysis revealed that the association of gastrointestinal bleeding with dasatinib was affected by age (≥60 years) and sex (female), with the number and proportion of dasatinib-related gastrointestinal bleeding cases increasing among those aged ≥60 years. Conclusions: Specific TKIs and patient characteristics were associated with gastrointestinal bleeding. Our results aid the prompt identification and treatment of TKI-related gastrointestinal bleeding.
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Chen YL, Zou J, Zhang YL, Li WM. [Dose optimization: an individualized treatment strategy for chronic myeloid leukemia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2022; 43:436-440. [PMID: 35680605 PMCID: PMC9250953 DOI: 10.3760/cma.j.issn.0253-2727.2022.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Y L Chen
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - J Zou
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Y L Zhang
- Department of Hematology, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - W M Li
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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Murai K, Ureshino H, Kumagai T, Tanaka H, Nishiwaki K, Wakita S, Inokuchi K, Fukushima T, Yoshida C, Uoshima N, Kiguchi T, Mita M, Aoki J, Kimura S, Karimata K, Usuki K, Shimono J, Chinen Y, Kuroda J, Matsuda Y, Nakao K, Ono T, Fujimaki K, Shibayama H, Mizumoto C, Takeoka T, Io K, Kondo T, Miura M, Minami Y, Ikezoe T, Imagawa J, Takamori A, Kawaguchi A, Sakamoto J, Kimura S. Low-dose dasatinib in older patients with chronic myeloid leukaemia in chronic phase (DAVLEC): a single-arm, multicentre, phase 2 trial. THE LANCET HAEMATOLOGY 2021; 8:e902-e911. [DOI: 10.1016/s2352-3026(21)00333-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/20/2021] [Accepted: 10/20/2021] [Indexed: 12/30/2022]
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Stagno F, Breccia M, Annunziata M, Trawinska MM, Iurlo A, Sgherza N, Fava C, Gozzini A, Luciano L, Carmosino I, Bonifacio M, Sorà F, Leonetti Crescenzi S, Crugnola M, Gugliotta G, Galimberti S, Bucelli C, Colafigli G, Feo C, Tiribelli M, Mauro E, Russo Rossi A, Guarini A, Abruzzese E, Rosti G, Di Raimondo F, Latagliata R. Long term follow-up of frontline Dasatinib in older patients with chronic myeloid leukemia in chronic phase treated outside clinical trials: a real-life cohort observational study. Acta Oncol 2021; 60:1527-1533. [PMID: 34499575 DOI: 10.1080/0284186x.2021.1971292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND A limited amount of data has been published in chronic-phase chronic myeloid leukemia (CP-CML) patients aged >75 years treated frontline with second-generation tyrosine kinase inhibitors. AIMS To address this issue in a clinical 'real-life' setting, we retrospectively analyzed 45 CP-CML patients (pts) followed in 20 Italian Centers and treated frontline with dasatinib (DAS). PATIENTS AND METHODS Median age was 78.4 years (range 75-89.2 years). DAS starting dose was 100 mg QD in 35 pts (77.7%), 80 mg QD in 1 pts (2.2%) and 50 mg QD in 9 pts (20.1%), respectively. The median follow-up was 42.6 months (IQR 20.4 - 63.3). RESULTS Grade 3 and 4 side effects, both hematological and non-hematological, were detected in 6 (13.3%) and 12 (26.6%) pts, respectively. Pleural effusions of all grades occurred in 13 pts (28.8%) after a median period of DAS exposure of 14.7 months (IQR 3.0 - 33.1). The rates of DAS dose reduction and permanent drug discontinuation were 53.3% and 20.0%, respectively. As the best response, 42/45 patients (93.3%) achieved a complete cytogenetic response (CCyR), 35/45 (77.7%) a major molecular response (MMR) and 24/45 (53.3%) a deep molecular response (both MR 4.0 and MR 4.5). Only 1 patient (2.2%) progressed to the blast phase after 13 months of therapy; 8 deaths were observed (1 CML-related and 7 CML-unrelated). Cumulative event-free survival and overall survival at 36 months were 64.7% (95%, CI 49.4 - 80.0) and 82.3% (95%, CI 70.3-94.3), respectively. CONCLUSION These findings, although evaluated in a limited and selected cohort of patients, suggest that DAS might be effective in older patients (aged >75 years) affected by CP-CML with acceptable toxicity.
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Affiliation(s)
- Fabio Stagno
- Hematology Section and BMT Unit, Rodolico Hospital, AOU Policlinico Rodolico-San Marco, Catania, Italy
| | - Massimo Breccia
- Department of Precision and Translational Medicine, Sapienza University, Rome, Italy
| | | | | | - Alessandra Iurlo
- Hematology Section, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Sgherza
- Hematology Unit, IRCCS “Casa Sollievo Sofferenza” Hospital, San Giovanni Rotondo, Italy
| | - Carmen Fava
- Hematology Section, Azienda Ospedaliera Mauriziano, Turin, Italy
| | | | | | - Ida Carmosino
- Department of Precision and Translational Medicine, Sapienza University, Rome, Italy
| | | | - Federica Sorà
- Hematology Section, Policlinico A. Gemelli, IRCSS Catholic University, Rome, Italy
| | | | | | - Gabriele Gugliotta
- Hematology Section “Seragnoli”, IRCCS AOU Bologna, University of Bologna, Bologna, Italy
| | | | - Cristina Bucelli
- Hematology Section, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gioia Colafigli
- Department of Precision and Translational Medicine, Sapienza University, Rome, Italy
| | - Costanzo Feo
- Immunohematology and Transfusion Unit, AORN “Gaetano Rummo”, Benevento, Italy
| | - Mario Tiribelli
- Hematology Section and BMT, University of Udine, Udine, Italy
| | - Endri Mauro
- Hematology Section, Dipartimento di Medicina Specialistica, Ca’ Foncello Hospital, Treviso, Italy
| | | | - Attilio Guarini
- Unit of Hematology and Cell Therapy, IRCCS-Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | | | | | - Francesco Di Raimondo
- Hematology Section and BMT Unit, Rodolico Hospital, AOU Policlinico Rodolico-San Marco, Catania, Italy
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Dose Optimization of Tyrosine Kinase Inhibitors in Chronic Myeloid Leukemia: A New Therapeutic Challenge. J Clin Med 2021; 10:jcm10030515. [PMID: 33535564 PMCID: PMC7867069 DOI: 10.3390/jcm10030515] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 12/18/2022] Open
Abstract
The chronic myeloid leukemia (CML) therapeutic landscape has dramatically changed with tyrosine kinase inhibitor (TKI) development, which allows a near-normal life expectancy. However, long-term TKI exposure has been associated with persistent adverse events (AEs) which negatively impact on quality of life (QoL) and have the potential to cause significant morbidity and mortality. In clinical practice, TKI dose reduction is usually considered to reduce AEs and improve QoL, but dose optimization could have also another aim, i.e., the achievement and maintenance of cytogenetic and molecular responses. While therapy cessation appeared as a safe option for about half of the patients achieving an optimal response, no systematic assessment of long-term TKI dose de-escalation has been made. The present review is focused on the most recent evidences for TKIs dose modifications in CML clinical studies and in the real-life setting. It will consider TKI dose modifications in newly diagnosed patients, dose reduction for AEs, or in deep molecular response, either as a prelude to treatment-free remission (TFR) or as continuous maintenance therapy in those patients not wishing to attempt TFR. In addition, it will focus on patients not achieving a molecular response deep enough to go to TFR, and for whom dose reduction could be an option to avoid AEs.
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Seo HY, Ko TH, Hyun SY, Song H, Lim ST, Shim KY, Lee JI, Kong JH. Tyrosine Kinase Inhibitor Dosing Patterns in Elderly Patients With Chronic Myeloid Leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:735-743.e2. [PMID: 31563565 DOI: 10.1016/j.clml.2019.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 08/21/2019] [Accepted: 08/21/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Tyrosine kinase inhibitors (TKIs) improve the survival rate of patients with chronic myeloid leukemia (CML). However, elderly patients often experience adverse events and require dose adjustments, leading to dose interruptions or treatment discontinuation. We therefore investigated TKI dosing patterns and subsequent outcomes in elderly CML patients. PATIENTS AND METHODS Using the National Health Information Database, we identified patients with CML aged ≥ 70 years who were prescribed TKIs (imatinib, dasatinib, nilotinib, or radotinib) during 2007-2013. Data on age, sex, prescribed medication, and date of death were extracted. RESULTS Among the 378 patients, the median age was 75 (range, 70-92) years; the median follow-up period was 53 (range, 1-133) months. Imatinib, dasatinib, nilotinib, and radotinib were prescribed to 324 (85.7%), 110 (29.1%), 93 (24.6%), and 15 (4.0%) patients, respectively. In 42 patients (12.2%), the initial dose was lower than the recommended dose for chronic-phase CML. At last follow-up, 249 patients (65.9%) were receiving a reduced dose. The mean ± standard deviation dose densities of imatinib, dasatinib, nilotinib, and radotinib were 207 ± 121.6, 29 ± 26.7, 235 ± 197, and 123 ± 95.4 mg/day, respectively. The estimated 5-year overall survival probability was 61.0%. Initial TKI dose or dose reduction within first year did not affect the overall survival (P = .0571 and .1826, respectively). CONCLUSION Dose reduction was observed in 65.9% of the patients at their last visit; except for imatinib, TKI dose densities were < 50% of the recommended dose for the chronic phase. Therefore, the recommended TKI doses might be too high for elderly patients with CML.
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Affiliation(s)
- Hee Yeon Seo
- Division of Oncology and Hematology, Department of Internal Medicine, Konkuk University School of Medicine, Chungju, Korea
| | - Tae Hwa Ko
- Center of Biomedical Data Science, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Shin Young Hyun
- Division of Oncology and Hematology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hyebin Song
- Division of Oncology and Hematology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seung Taek Lim
- Division of Oncology and Hematology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Kwang Yong Shim
- Division of Oncology and Hematology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jong In Lee
- Division of Oncology and Hematology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jee Hyun Kong
- Division of Oncology and Hematology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea.
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Shallis RM, Podoltsev N. What is the best pharmacotherapeutic strategy for treating chronic myeloid leukemia in the elderly? Expert Opin Pharmacother 2019; 20:1169-1173. [PMID: 30951394 DOI: 10.1080/14656566.2019.1599357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Rory M Shallis
- a Division of Hematology , Yale University Yale Cancer Center , New Haven , CT , USA
| | - Nikolai Podoltsev
- a Division of Hematology , Yale University Yale Cancer Center , New Haven , CT , USA
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Eskazan AE. Starting with a lower daily dose of dasatinib in patients with chronic myeloid leukemia in chronic phase: Less is more, or is it? Cancer 2018; 124:4260-4261. [PMID: 30276792 DOI: 10.1002/cncr.31682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 06/25/2018] [Indexed: 01/10/2023]
Affiliation(s)
- Ahmet Emre Eskazan
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Won AM, Boddu P, Otun AO, Aponte-Wesson R, Chambers M. Chronic myelogenous leukemia presenting with osteonecrosis of the jaw as a rare but debilitating toxicity of dasatinib: a case report and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:e208-e211. [PMID: 29941400 DOI: 10.1016/j.oooo.2018.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/07/2018] [Accepted: 05/18/2018] [Indexed: 12/22/2022]
Abstract
This report describes a case of osteonecrosis of the jaw developing after a routine dental extraction in a patient being treated with dasatinib, a tyrosine kinase inhibitor, for chronic myelogenous leukemia. As the role of tyrosine kinase inhibitors in cancer treatment expands, patterns of debilitating complications involving the osseous structures of the oral cavity have begun to emerge, and many long-term side effects of this promising therapy remain unknown. To limit the occurrence of known complications, health care providers and patients must be aware of the potential for serious complications of dasatinib, and appropriate protocols should be in place before administration of this medication.
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Affiliation(s)
- Alexander M Won
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Prajwal Boddu
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Adegbenga O Otun
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ruth Aponte-Wesson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark Chambers
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Ota S, Matsukawa T, Yamamoto S, Ito S, Shindo M, Sato K, Kondo T, Kohda K, Sakai H, Mori A, Takahashi T, Ikeda H, Kuroda H, Haseyama Y, Yamamoto M, Sarashina T, Yoshida M, Kobayashi R, Nishio M, Ishihara T, Hirayama Y, Kakinoki Y, Kobayashi H, Fukuhara T, Imamura M, Kurosawa M. Severe adverse events by tyrosine kinase inhibitors decrease survival rates in patients with newly diagnosed chronic-phase chronic myeloid leukemia. Eur J Haematol 2018; 101:95-105. [PMID: 29660177 DOI: 10.1111/ejh.13081] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVE This multicenter cooperative study aimed to analyze the adverse events (AEs) associated with tyrosine kinase inhibitors (TKIs) used as initial treatment for chronic-phase chronic myeloid leukemia (CML-CP) and their impact on outcome. METHODS We retrospectively evaluated 450 patients with CML-CP who received TKIs between 2004 and 2014. RESULTS The 5-year overall survival (OS) and event-free survival (EFS) rates were 95.1% and 89.0%, respectively. Patients with comorbidities (46.4%) and aged ≥60 years (50.4%) at diagnosis had significantly inferior OS to those without comorbidities and aged <60. Patients achieved higher rates of major molecular response (MMR) at 6 and 12 months after initial treatment with dasatinib or nilotinib compared to imatinib, but final MMR rates were almost the same. Sixty-six percent of patients required treatment modifications from first-line TKI therapy; the main reasons were AEs (48.4%) and failure (18%). Grade III-IV AEs in first-line TKI therapy were significantly correlated to inferior OS/EFS compared to grade 0-II AEs. CONCLUSION Although long-term outcomes were similar in CML-CP patients treated with each TKI regardless of first-line TKI selection, severe AEs in first-line TKI therapy decreased their survival rates. Early change in TKIs is recommended, when faced with severe AEs of specific TKIs.
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Affiliation(s)
- Shuichi Ota
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan
| | | | - Satoshi Yamamoto
- Department of Hematology, Sapporo City General Hospital, Sapporo, Japan
| | - Shinichi Ito
- Department of Hematology, Hakodate Municipal Hospital, Hakodate, Japan
| | - Motohiro Shindo
- Department of Hematology, Asahikawa Medical University, Asahikawa, Japan
| | - Kazuya Sato
- Department of Hematology/Oncology, Asahikawa Kosei Hospital, Asahikawa, Japan
| | - Takeshi Kondo
- Faculty of Medicine and Graduate School of Medicine, Department of Hematology, Hokkaido University, Sapporo, Japan
| | - Kyuhei Kohda
- Department of Hematology, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan
| | - Hajime Sakai
- Department of Hematology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Akio Mori
- Department of Hematology, Aiiku Hospital, Sapporo, Japan
| | | | - Hiroshi Ikeda
- Department of Hematology, Sapporo Medical University, Sapporo, Japan
| | - Hiroyuki Kuroda
- Department of Hematology, Steel Memorial Muroran Hospital, Muroran, Japan
| | | | - Masaki Yamamoto
- Department of Pediatrics, Sapporo Medical University, Sapporo, Japan
| | - Takeo Sarashina
- Department of Pediatrics, Asahikawa Medical University, Asahikawa, Japan
| | - Makoto Yoshida
- Department of Pediatrics, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan
| | - Ryoji Kobayashi
- Department of Hematology/Oncology for Children and Adolescent, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Mitsufumi Nishio
- Department of Hematology and Oncology, NTT East Japan Sapporo Hospital, Sapporo, Japan
| | | | - Yasuo Hirayama
- Department of Hematology, Higashisapporo Hospital, Sapporo, Japan
| | | | - Hajime Kobayashi
- Department of Hematology, Obihiro Kosei Hospital, Obihiro, Japan
| | | | - Masahiro Imamura
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan
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Imamura M, Nakamura Y, Sugawara M. Plasma and intracellular concentrations in an elderly patient with chronic myeloid leukemia receiving low-dose dasatinib therapy. Geriatr Gerontol Int 2018. [PMID: 29542294 DOI: 10.1111/ggi.13238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Masahiro Imamura
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Yusuke Nakamura
- Department of Pharmacy, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Mitsuru Sugawara
- Department of Biopharmaceutical Sciences and Pharmacy, Laboratory of Pharmacokinetics, Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan
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Luskin MR, DeAngelo DJ. How to treat chronic myeloid leukemia (CML) in older adults. J Geriatr Oncol 2018; 9:291-295. [PMID: 29463446 DOI: 10.1016/j.jgo.2018.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/03/2018] [Accepted: 01/23/2018] [Indexed: 01/07/2023]
Abstract
Chronic myeloid leukemia (CML), a myeloproliferative neoplasm defined by the t(9;22)(q34;q11) chromosomal translocation, primarily affects older adults. Historically, effective treatment options were not available for older CML patients ineligible for curative allogeneic stem cell transplant, and the disease was therefore usually fatal within several years of diagnosis. The development of tyrosine kinase inhibitors (TKIs) that effectively target the constitutively active mutant tyrosine kinase in CML has dramatically improved outcomes for all patients with CML, including older patients. While older patients were underrepresented in prospective trials, TKI therapy can be successfully administered to older adults with CML with excellent efficacy and proven tolerability. TKI selection and monitoring for adverse events should be tailored based on co-morbidities. As with younger patients, life expectancy of older adults with CML now approaches that of age-matched controls. Here we review guidelines for management of older adults with CML.
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Affiliation(s)
- Marlise R Luskin
- Dana-Farber Cancer Institute, 450 Brookline Avenue Boston, MA 02215, USA; Harvard Medical School, Boston, MA, USA.
| | - Daniel J DeAngelo
- Dana-Farber Cancer Institute, 450 Brookline Avenue Boston, MA 02215, USA; Harvard Medical School, Boston, MA, USA.
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Tokuhira M, Kimura Y, Sugimoto K, Nakazato T, Ishikawa M, Fujioka I, Takaku T, Iriyama N, Sato E, Fujita H, Hatta Y, Komatsu N, Asou N, Kizaki M, Kawaguchi T. Efficacy and safety of nilotinib therapy in patients with newly diagnosed chronic myeloid leukemia in the chronic phase. Med Oncol 2018; 35:38. [PMID: 29442179 DOI: 10.1007/s12032-018-1093-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 01/31/2018] [Indexed: 01/28/2023]
Abstract
ABL1-tyrosine kinase inhibitors (TKIs) have led to dramatic changes in treatment strategies for chronic myeloid leukemia in the chronic phase (CML-CP). However, clinical studies have highlighted increasing numbers of adverse events (AE) with TKIs. Although TKI modification plays a key role in AE management, this process is poorly understood, particularly in terms of the TKI nilotinib. In the present study, we retrospectively analyzed the records of 70 patients with newly diagnosed (ND)-CML-CP who were treated with nilotinib to investigate the drug potency of nilotinib and treatment management. During a median observation period of 3.4 years, 76% of patients continued nilotinib as a first-line treatment. The 1-year and overall major molecular response (MMR) rates and the overall molecular response (MR) 4.5 rate for all patients receiving first-line nilotinib therapy were 70, 84.2, and 50%, respectively. No case progressed to the accelerated or blast phase during the study. To avoid AEs during the early phase, nilotinib doses were reduced to < 600 mg/day in a third of patients (Reduced group); these patients experienced better therapeutic efficacy and a lower rate of AEs relative to those in Standard group (300 mg twice daily). Ten patients who received < 600 mg/day of nilotinib throughout the study had a 1-year MMR rate and overall MR4.5 rate of 90 and 60%, respectively. In summary, our findings indicate that careful management, including dose reduction, can yield better outcomes in patients with ND-CML-CP.
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Affiliation(s)
- Michihide Tokuhira
- Department of Hematology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan.
| | - Yuta Kimura
- Department of Hematology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Keiji Sugimoto
- Department of Hematology, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Tomonori Nakazato
- Department of Hematology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Maho Ishikawa
- Department of Hemato-Oncology, Comprehensive Cancer Center, Saitama International Medical Center, Saitama Medical University, Saitama, Japan
| | - Isao Fujioka
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Tomoiku Takaku
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Noriyoshi Iriyama
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Eriko Sato
- Division of Hematology, Department of Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Hiroyuki Fujita
- Department of Hematology, Saiseikai Yokohama Nanbu Hospital, Yokohama, Japan
| | - Yoshihiro Hatta
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Norio Komatsu
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Norio Asou
- Department of Hemato-Oncology, Comprehensive Cancer Center, Saitama International Medical Center, Saitama Medical University, Saitama, Japan
| | - Masahiro Kizaki
- Department of Hematology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Tatsuya Kawaguchi
- Department of Hematology and Infectious Diseases, Kumamoto University Hospital, Kumamoto, Japan
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Gomez-de-León A, Gómez-Almaguer D, Ruiz-Delgado GJ, Ruiz-Arguelles GJ. Insights into the management of chronic myeloid leukemia in resource-poor settings: a Mexican perspective. Expert Rev Hematol 2017; 10:809-819. [PMID: 28742419 DOI: 10.1080/17474086.2017.1360180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The arrival of targeted therapy for chronic myeloid leukemia (CML) was revolutionary. However, due to the high cost of tyrosine kinase inhibitors, access to this highly effective therapy with strict monitoring strategies is limited in low to middle-income countries. In this context, following standard recommendations proposed by experts in developed countries is difficult. Areas covered: This review aims to provide an insight into the management of patients with CML living in a resource-limited setting. It addresses several issues: diagnosis, initial treatment, disease monitoring, and additional treatment alternatives including allogeneic hematopoietic stem cell transplantation. Expert commentary: Imatinib is probably the most cost-effective TKI for initial treatment in developing and underdeveloped countries. Generic imatinib preparations should be evaluated before considering their widespread use. Adherence to treatment should be emphasized. Adequate monitoring can be performed through several methods successfully and is important for predicting outcomes, particularly early in the first year, and if treatment suspension is being considered. Access to further therapeutic alternatives should define our actions after failure or intolerance to imatinib, preferring additional TKIs if possible. Allogeneic transplantation in chronic phase is a viable option in this context.
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Affiliation(s)
- Andrés Gomez-de-León
- a Universidad Autónoma de Nuevo León , Facultad de Medicina y Hospital Universitario "Dr.José Eleuterio González". Hematology Service, Monterrey , Nuevo León , México
| | - David Gómez-Almaguer
- a Universidad Autónoma de Nuevo León , Facultad de Medicina y Hospital Universitario "Dr.José Eleuterio González". Hematology Service, Monterrey , Nuevo León , México
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