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Yu L, Wang H, Gale RP, Qin Y, Lai Y, Shi H, Dou X, Huang X, Jiang Q. Impact of socio-demographic co-variates on prognosis, tyrosine kinase-inhibitor use and outcomes in persons with newly-diagnosed chronic myeloid leukaemia. J Cancer Res Clin Oncol 2021; 148:449-459. [PMID: 33835260 DOI: 10.1007/s00432-021-03624-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Define the impact of socio-demographic co-variates on outcomes of persons with newly-diagnosed chronic phase chronic myeloid leukaemia (CML). METHODS Data of 961 consecutive subjects with newly-diagnosed CML were integrated for these outcomes in multi-variable Cox regression analyses after adjusting for confounders and interactions. RESULTS Elder age was associated with less use of a 2nd generation TKI as initial therapy. Household registration, comorbidity(ies) and education level were associated with use of a generic rather than branded TKI as initial therapy. Subjects with lower education level were more likely to be diagnosed with CML because of leukaemia-related symptoms. Rural registration and lower education level were also associated with a greater likelihood of switching TKI-therapy. Lower education level was associated with lower likelihood of achieving MMR [HR = 0.8 (0.7, 0.9), p = 0.002], MR4.5 [HR = 0.8 (0.7, 1.0), p = 0.055], and poor FFS [HR = 1.7 (1.3, 2.5); p < 0.001], PFS [HR = 2.0 (1.1, 5.0); p = 0.014], CML-related survival [HR = 2.5 (1.0, 10.0); p = 0.060] and survival [HR = 2.5 (1.0, 10.0); p = 0.043]. Males had lower rates of MMR and MR4.5 and worse FFS, but not survival compared with females. Being married was associated with a higher rate of MR4.5, fewer failures, progressions, and deaths. CONCLUSION Socio-demographic co-variates have a strong impact on therapy choice and responses in persons with newly-diagnosed CML, including circumstances of diagnosis, risk category and prognosis, use of initial TKI, switching TKIs, response to TKI-therapy, and outcomes.
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MESH Headings
- Adolescent
- Adult
- Aged
- Demography
- Disease Progression
- Female
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/epidemiology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Male
- Middle Aged
- Prognosis
- Protein Kinase Inhibitors/therapeutic use
- Protein-Tyrosine Kinases/antagonists & inhibitors
- Socioeconomic Factors
- Surveys and Questionnaires
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Lu Yu
- National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Huifang Wang
- National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Robert Peter Gale
- Centre for Haematology Research, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Yazhen Qin
- National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Yueyun Lai
- National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Hongxia Shi
- National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Xuelin Dou
- National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Xiaojun Huang
- National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Qian Jiang
- National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Beijing, 100044, China.
- Collaboratives Innovation Center of Hematology, Soochow University, Suzhou, China.
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Sampaio MM, Santos MLC, Marques HS, Gonçalves VLDS, Araújo GRL, Lopes LW, Apolonio JS, Silva CS, Santos LKDS, Cuzzuol BR, Guimarães QES, Santos MN, de Brito BB, da Silva FAF, Oliveira MV, Souza CL, de Melo FF. Chronic myeloid leukemia-from the Philadelphia chromosome to specific target drugs: A literature review. World J Clin Oncol 2021; 12:69-94. [PMID: 33680875 PMCID: PMC7918527 DOI: 10.5306/wjco.v12.i2.69] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/22/2020] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm and was the first neoplastic disease associated with a well-defined genotypic anomaly - the presence of the Philadelphia chromosome. The advances in cytogenetic and molecular assays are of great importance to the diagnosis, prognosis, treatment, and monitoring of CML. The discovery of the breakpoint cluster region (BCR)-Abelson murine leukemia (ABL) 1 fusion oncogene has revolutionized the treatment of CML patients by allowing the development of targeted drugs that inhibit the tyrosine kinase activity of the BCR-ABL oncoprotein. Tyrosine kinase inhibitors (known as TKIs) are the standard therapy for CML and greatly increase the survival rates, despite adverse effects and the odds of residual disease after discontinuation of treatment. As therapeutic alternatives, the subsequent TKIs lead to faster and deeper molecular remissions; however, with the emergence of resistance to these drugs, immunotherapy appears as an alternative, which may have a cure potential in these patients. Against this background, this article aims at providing an overview on CML clinical management and a summary on the main targeted drugs available in that context.
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Affiliation(s)
- Mariana Miranda Sampaio
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Maria Luísa Cordeiro Santos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Hanna Santos Marques
- Campus Vitória da Conquista, Universidade Estadual do Sudoeste da Bahia, Vitória da Conquista 45083-900, Bahia, Brazil
| | | | - Glauber Rocha Lima Araújo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Luana Weber Lopes
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Jonathan Santos Apolonio
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Camilo Santana Silva
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Luana Kauany de Sá Santos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Beatriz Rocha Cuzzuol
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | | | - Mariana Novaes Santos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Breno Bittencourt de Brito
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | | | - Márcio Vasconcelos Oliveira
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Cláudio Lima Souza
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Fabrício Freire de Melo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
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Xu L, Chen H, Chen J, Han M, Huang H, Lai Y, Liu D, Liu Q, Liu T, Jiang M, Ren H, Song Y, Sun Z, Wang J, Wu D, Zhou D, Zou P, Liu K, Huang X. The consensus on indications, conditioning regimen, and donor selection of allogeneic hematopoietic cell transplantation for hematological diseases in China-recommendations from the Chinese Society of Hematology. J Hematol Oncol 2018; 11:33. [PMID: 29495966 PMCID: PMC5833104 DOI: 10.1186/s13045-018-0564-x] [Citation(s) in RCA: 213] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/02/2018] [Indexed: 02/05/2023] Open
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is widely used to treat malignant hematological neoplasms and non-malignant hematological disorders. Approximately, 5000 allo-HSCT procedures are performed in China annually. Substantial progress has been made in haploidentical HSCT (HID-HSCT), pre-transplantation risk stratification, and donor selection in allo-HSCT, especially after the establishment of the "Beijing Protocol" HID-HSCT system. Transplant indications for selected subgroups in low-risk leukemia or severe aplastic anemia (SAA) differ from those in the Western world. These unique systems developed by Chinese doctors may inspire the refining of global clinical practice. We reviewed the efficacy of allo-HSCT practice from available Chinese studies on behalf of the HSCT workgroup of the Chinese Society of Hematology, Chinese Medical Association and compared these studies to the consensus or guideline outside China. We summarized the consensus on routine practices of all-HSCT in China and focused on the recommendations of indications, conditioning regimen, and donor selection.
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MESH Headings
- Anemia, Aplastic/epidemiology
- Anemia, Aplastic/therapy
- China/epidemiology
- Donor Selection/methods
- Donor Selection/standards
- Hematologic Diseases/epidemiology
- Hematologic Diseases/therapy
- Hematopoietic Stem Cell Transplantation/methods
- Hematopoietic Stem Cell Transplantation/standards
- Humans
- Leukemia/epidemiology
- Leukemia/therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/epidemiology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Leukemia, Myeloid, Acute/epidemiology
- Leukemia, Myeloid, Acute/therapy
- Myelodysplastic Syndromes/epidemiology
- Myelodysplastic Syndromes/therapy
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/epidemiology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy
- Societies, Medical
- Transplantation Conditioning/methods
- Transplantation Conditioning/standards
- Transplantation, Homologous/methods
- Transplantation, Homologous/standards
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Affiliation(s)
- Lanping Xu
- Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Peking University People’s Hospital & Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044 People’s Republic of China
| | - Hu Chen
- Affiliated Hospital of The Academy of Military Medical Sciences, Beijing, People’s Republic of China
| | - Jing Chen
- Shanghai Children’s Medical Center, Shanghai, People’s Republic of China
| | - Mingzhe Han
- Chinese Academy of Medical Sciences and Peking Union Medical College, Institute of Hematology and Blood Disease Hospital, Tianjin, People’s Republic of China
| | - He Huang
- First Affiliated Hospital of Zhejiang University, Hangzhou, People’s Republic of China
| | - Yongrong Lai
- The First Affiliated Hospital of Guangxi Medical University, Guilin, People’s Republic of China
| | - Daihong Liu
- General Hospital of PLA(People’s Liberation Army of China), Beijing, People’s Republic of China
| | - Qifa Liu
- Nanfang Hospital of Southern Medical University, Guangzhou, People’s Republic of China
| | - Ting Liu
- West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Ming Jiang
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Hanyun Ren
- Peking University First Hospital, Beijing, People’s Republic of China
| | - Yongping Song
- Henan Cancer Hospital, Zhengzhou, People’s Republic of China
| | - Zimin Sun
- Anhui Provincial Hospital, Hefei, People’s Republic of China
| | - Jianmin Wang
- Changhai Hospital of Shanghai, Shanghai, People’s Republic of China
| | - Depei Wu
- The First Affiliated Hospital of Soochow Hospital, Soochow, People’s Republic of China
| | - Daobin Zhou
- Peking Union Medical College Hospital, Beijing, People’s Republic of China
| | - Ping Zou
- Tongji Medical College, Wuhan Union Hospital, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Kaiyan Liu
- Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Peking University People’s Hospital & Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044 People’s Republic of China
| | - Xiaojun Huang
- Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Peking University People’s Hospital & Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044 People’s Republic of China
- Peking-Tsinghua Center for Life Sciences, Beijing, People’s Republic of China
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Reduced-intensity allogeneic hematopoietic stem cell transplantation combined with imatinib has comparable event-free survival and overall survival to long-term imatinib treatment in young patients with chronic myeloid leukemia. Ann Hematol 2017. [PMID: 28624905 DOI: 10.1007/s00277-017-3021-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The relative merits of reduced intensity hematopoietic stem cell transplantation (RIST) for chronic myeloid leukemia (CML) in the first chronic phase (CP) in imatinib era have not been evaluated. The study was designed to compare the outcomes of combination therapy of RIST plus imatinib (RIST + IM) vs. imatinib (IM) alone for young patients with early CP (ECP) and late CP (LCP). Of the patients, 130 were non-randomly assigned to treatment with IM alone (n = 88) or RIST + IM (n = 42). The 10-year overall survival (OS) and event-free survival (EFS) were comparable between RIST + IM and IM groups. LCP, high Sokal score, and no complete cytogenetic response at 3 months were adverse prognostic factors for survival, but only the time from diagnosis to IM was an independent predictor after multivariate analysis. For ECP, IM was similar to RIST + IM, with 10-year EFS rates of 77.2 vs. 81.6% (p = 0.876) and OS rates of 93.8 vs. 87.9% (p = 0.102), respectively. For LCP, both treatments resulted in similar survival, but more patients in the imatinib group experienced events (10-year EFS 40.8 vs. 66.7%, p = 0.047). The patients with higher EBMT risk scores had an inferior survival than those with lower scores (69.2 vs. 92.9%, p = 0.04). We concluded that RIST + IM was comparable to IM in terms of OS and EFS. However, RIST + IM was more affordable than IM alone in a 10-year scale. Thus, RIST + IM could be considered as an alternative treatment option, especially when the patients have low EBMT risk scores and demand a definite cure for CML.
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Sheng G, Chen S, Dong C, Zhang R, Miao M, Wu D, Tan SC, Liu C, Xiong T. Societal implications of medical insurance coverage for imatinib as first-line treatment of chronic myeloid leukemia in China: a cost-effectiveness analysis. J Med Econ 2017; 20:371-381. [PMID: 27936995 DOI: 10.1080/13696998.2016.1271336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Imatinib (Glivec) and nilotinib (Tasigna) have been covered by critical disease insurance in Jiangsu province of China since 2013, which changed local treatment patterns and outcomes of patients with chronic myeloid leukemia (CML). This study evaluated the long-term cost-effectiveness of insurance coverage with imatinib as the first-line treatment for patients with CML in China from a societal perspective. METHODS A decision-analytic model based on previously published and real-world evidence was applied to simulate and evaluate the lifetime clinical and economic outcomes associated with CML treatments before and after imatinib was covered by medical insurance. Incremental cost-effectiveness ratio (ICER) was calculated with both costs and quality-adjusted life years (QALYs) discounted at 3% annually. Different assumptions of treatment benefits and costs were taken to address uncertainties and were tested with sensitivity analyses. RESULTS In base case analysis, both cost and effectiveness of CML treatments increased after imatinib was covered by the medical insurance; on average, the incremental QALY and cost were 5.5 and ¥277,030 per patient in lifetime, respectively. The ICER of insurance coverage with imatinib was ¥50,641, which is less than the GDP per capita of China. Monte Carlo simulation resulted in the estimate of 100% probability that the insurance coverage of imatinib is cost-effective. Total cost was substantially saved at 5 years after patients initiated imatinib treatment with insurance coverage compared to no insurance coverage, the saved cost at 5 years was ¥99,565, which included the cost savings from both direct (e.g. cost of bone marrow or stem cell transplant) and indirect costs (e.g. productivity loss of patients and care-givers). CONCLUSIONS The insurance coverage of imatinib is very cost-effective in China, according to the local cost and clinical data in Jiangsu province. More importantly, the insurance coverage of imatinib and nilotinib have changed the treatment patterns of CML patients, thus dramatically increasing life expectancy and quality-of-life (QoL) saving on productivity losses for both CML patients and their caregivers.
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Affiliation(s)
- Guangying Sheng
- a Department of Hematology , Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, the First Affiliated Hospital of Soochow University , Suzhou , PR China
| | - Suning Chen
- a Department of Hematology , Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, the First Affiliated Hospital of Soochow University , Suzhou , PR China
| | - Chaohui Dong
- b Institute for Social Security Research, Ministry of Human Resources and Social Security of P.R.C , Beijing , PR China
| | - Ri Zhang
- a Department of Hematology , Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, the First Affiliated Hospital of Soochow University , Suzhou , PR China
| | - Miao Miao
- a Department of Hematology , Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, the First Affiliated Hospital of Soochow University , Suzhou , PR China
| | - Depei Wu
- a Department of Hematology , Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, the First Affiliated Hospital of Soochow University , Suzhou , PR China
| | - Seng Chuen Tan
- c Health Economics & Outcomes Research, IMS Health Asia Pacific , Singapore
| | - Chao Liu
- d Novartis Oncology (China) , Beijing , PR China
| | - Tengbin Xiong
- e Health Economics & Outcomes Research, IMS Health China , Shanghai , PR China
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Yu L, Wang HB, Huang XJ, Jiang Q. [The impact of Glivec related side effects on daily life in Chinese patients with chronic myeloid leukemia in the chronic phase]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2017; 37:554-8. [PMID: 27535853 PMCID: PMC7365006 DOI: 10.3760/cma.j.issn.0253-2727.2016.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
目的 评估中国服用伊马替尼原研药格列卫的慢性髓性白血病(CML)慢性期患者药物不良反应对其日常生活的影响。 方法 2014年5月至11月,在全国范围内向正在接受酪氨酸激酶抑制剂(TKI)治疗的成年CML患者发放无记名调查问卷。TKI不良反应对患者日常生活的影响程度采用自我报告的形式,以1(没有影响)至5分(严重影响)评估。分析对象为其中正在服用格列卫的CML慢性期患者。 结果 共收集548例服用格列卫的CML慢性期受访者的答卷,其中,男性303例(55%),中位年龄40(18~88)岁,437例(80%)确诊至开始格列卫治疗时间<1年。中位服用格列卫3(<1~13)年,442例(81%)获得完全细胞遗传学反应,261例(48%)获得完全分子学反应。格列卫最多见的不良反应依次为:水肿(51%)、乏力(40%)、胃肠道不适(35%)、肌肉痉挛(22%)、面部颜色改变(22%)、体重增加(13%)、皮疹(11%)、肝功能异常(10%)和血细胞计数降低(7%)。患者自我报告格列卫相关的不良反应导致的日常生活受影响程度评分为(2.4±1.2)分,161例(29%)没有影响(1分),295例(54%)轻中度影响(2~3分),92例(17%)严重影响(4~5分)。多因素分析显示,格列卫服药时间<4年(OR=1.9,95% CI 1.3~2.6;P<0.001)、乏力(OR=2.9,95% CI 2.1~4.1;P<0.001)、水肿(OR=2.2, 95% CI 1.6~3.1;P< 0.001)、胃肠道不适(OR=2.6, 95% CI 1.9~3. 7;P<0.001)、皮疹(OR=2.1,95% CI 1.2~3.4;P=0.005)和肝功能异常(OR=2.3, 95% CI 1.4~3.9;P=0.001)与患者较高的日常生活受影响程度评分显著相关。 结论 服用格列卫的中国CML慢性期患者中,少数患者因药物不良反应而严重影响其日常生活,特别是在治疗的前4年。乏力、水肿、胃肠道不适、皮疹和肝功能异常是主要的影响患者日常生活的不良反应。
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Affiliation(s)
- L Yu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
| | | | | | - Q Jiang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
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Jiang Q, Liu ZC, Zhang SX. [A survey on tyrosine kinase inhibitor treatment in patients with chronic myeloid leukemia in China: from patients'perspective]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2016; 37:559-64. [PMID: 27535854 PMCID: PMC7365001 DOI: 10.3760/cma.j.issn.0253-2727.2016.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To assess tyrosine kinase inhibitor (TKI) treatment status in patients with chronic myeloid leukemia (CML) in China and analyze the response-associated factors. METHODS From May to November in 2014, anonymous questionnaires were distributed to adult CML patients who were receiving TKI treatment all over China. RESULTS 1 038 questionnaires were collected, 949 questionnaires were evaluable. Of the 949 evaluable respondents, 549 (58%) were male with the median age of 41 years (range, 18 to 88 years). 623 (66%) respondents lived in an urban area and 449 (47%) had an education level ≥ a bachelor degree. 888 (94%) respondents were in the chronic phase at diagnosis, and 690 (78%) of them started TKI treatment within one year after diagnosis. 794 (84%) respondents were on imatinib, 768 (81%) on the branded. With a median TKI treatment duration of 3 years (range, <1 to 13 years), 708 of 834 (85%) evaluable respondents achieved Ph- negative (i.e. complete cytogenetic response, CCyR), and 497 of 859 (46% ) BCR- ABL negative (i.e. complete molecular response, CMR). Multivariate analyses showed that female (OR=1.8, 95% CI 1.1-2.8,P=0.019 andOR=1.5, 95% CI 1.1-2.0,P=0.015), TKI treatment duration >3 years (OR=4.1, 95% CI 2.6- 6.5,P<0.001 andOR=3.7, 95% CI 2.7- 5.1,P< 0.001) and imatinib taken (OR=2.1, 95% CI 1.2-3.7,P=0.007 andOR=3.3, 95% CI 2.1-5.1,P<0.001) were factors affecting achieving both CCyR and CMR. In addition, higher education level (OR=2.0, 95% CI 1.3- 3.1,P=0.003), starting TKI treatment <1 year (OR=2.4, 95% CI 1.5- 3.8,P<0.001) and branded drugs received (OR=2.4, 95% CI 1.4- 4.0,P=0.001) were factors affecting achieving a CCyR. In 884 respondents, 534 (62%) reported " heavy financial burden" as the biggest treatment impediment, only 152 (17%) reported " poor quality of life related to adverse effects of TKI". CONCLUSIONS The survey showed that majority of the Chinese CML patients received imatinib as a TKI therapy, and most of the patients achieved satisfied responses by TKI. Financial burden became the major obstacle during TKI treatment.
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Affiliation(s)
- Q Jiang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
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Jiang Q. [How I treat newly diagnosed chronic myeloid leukemia in chronic phase]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2016; 37:545-9. [PMID: 27535851 PMCID: PMC7365010 DOI: 10.3760/cma.j.issn.0253-2727.2016.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Indexed: 11/05/2022]
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Fighting against hematological malignancy in China: from unique system to global impact. SCIENCE CHINA-LIFE SCIENCES 2015; 58:1183-90. [PMID: 26566805 DOI: 10.1007/s11427-015-4926-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 08/16/2015] [Indexed: 12/13/2022]
Abstract
During recent decades, substantial progress has been made in clinical strategies for treating hematological malignancies. Not only did China benefit from the global progression in the management of acute promyelocytic leukemia, risk-stratification-directed strategies for acute or chronic leukemia and haploidentical hematopoietic stem cell transplantation, the unique system developed by Chinese doctors has also become inspiration for refining global clinical practice. The multicenter trials and collaborations adhering to international standards might further strengthen the global impact and lead the way in specific fields of research worldwide.
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Jiang Q, Zhao D, Jin J, Wu D, Meng F, Hu J, Liu B, DU X, Liu T, Li Y, Hou M, Han X, Shen Z, Ma J. [A prospective, multi-centre clinical trial to evaluate the early clinical efficacy and safety of a generic imatinib in treating patients with chronic phase of chronic myelogenous leukemia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2015; 36:651-5. [PMID: 26462633 PMCID: PMC7348277 DOI: 10.3760/cma.j.issn.0253-2727.2015.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate the early hematologic, cytogenetic and molecular responses in newly diagnosed patients with chronic myelogenous leukemia in chronic phase(CML-CP)and initially treated with a generic imatinib(Xinwei), manufactured by Jiansu Hansoh Pharmaceutical Group Co., Ltd. METHODS 107 newly diagnosed patients of CML-CP, whose ages were above 18- year- old and who had never received any tyrosine kinase inhibitor(TKI)were treated with Xinwei 400 mg QD. The hematologic, cytogenetic and molecular responses were assessed at 3- and 6-month, and adverse effects were evaluated throughout the study. RESULTS 107 patients were treated with Xinwei for at least 3 months, 54 of them were treated for 6 months or more. At 3- month, the complete hematologic responses(CHR)rate were 98.1%(105/107); 47/57(82.5%) patients achieved major cytogenetic response(MCyR), and 20/57 (35.1%) patients complete cytogenetic response(CCyR); BCR- ABLIS was ≤10% in 77/106 patients (72.6%), 11 of them(10.4%)achieved major molecular response(MMR, BCR-ABLIS was ≤0.1%). At 6-month, the CHR rate was 100%(54/54); 28/39 patients(71.8%)achieved CCyR; BCR-ABLIS was ≤1% in 37/54 patients (68.5% ), 18 of them (33.3% ) achieved MMR. The grade Ⅲ leukopenia, thrombocytopenia and anemia rates were 19.5%, 23.0% and 13.8%, respectively. No grade Ⅳ hematologic toxicity occurred. The common non- hematologic toxicities were edema(74.7%), nausea(48.3%), bone pain(42.5%), rash(36.8%), diarrhea(34.5%), fever(23.0%), cramp(11.5%)and impaired liver function (3.4%). No patient experienced grade Ⅳ non- hematologic toxicity. No adverse effects related death occurred. CONCLUSION Our results revealed the excellent early haematology, cytogenetic and molecular responses and safety of Xinwei in treating patients with CML-CP.
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Affiliation(s)
| | - Donglu Zhao
- Hematologic Disease and Tumor Institute of Harbin, Harbin 150010, China
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- Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jun Ma
- Hematologic Disease and Tumor Institute of Harbin, Harbin 150010, China
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The role of hematopoietic stem cell transplantation in chronic myeloid leukemia. Ann Hematol 2015; 94 Suppl 2:S177-86. [PMID: 25814084 DOI: 10.1007/s00277-015-2313-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 12/07/2014] [Indexed: 12/28/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) is currently recommended as 2nd or 3rd line therapy for patients with chronic myeloid leukemia (CML) in first chronic phase or as salvage for patients with very advanced disease. As a consequence, numbers of HSCT in chronic phase have dropped significantly since the introduction of tyrosine kinase inhibitors (TKI), numbers of transplants in advanced disease to a lesser extent. These current recommendations consider primarily disease risk, defined as failure of TKI therapy; they might need to be adapted. We propose a more balanced appraisal of HSCT for individual patients which should include disease risk, transplant risk, and macroeconomic aspects. HSCT should be integrated into the treatment algorithms from diagnosis and be considered very early at first TKI failure for patients with high disease but low transplant risk. For patients with very advanced disease and high transplant risk in contrast, HSCT might only be recommended in a restricted research setting.
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Mo XD, Jiang Q, Xu LP, Liu DH, Liu KY, Jiang B, Jiang H, Chen H, Chen YH, Zhang XH, Han W, Wang Y, Huang XJ. Health-related quality of life of patients with newly diagnosed chronic myeloid leukemia treated with allogeneic hematopoietic SCT versus imatinib. Bone Marrow Transplant 2014; 49:576-80. [PMID: 24442252 DOI: 10.1038/bmt.2013.232] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 11/30/2013] [Accepted: 12/07/2013] [Indexed: 11/09/2022]
Abstract
To evaluate and compare the health-related quality of life (HRQOL) of patients with newly diagnosed CML in the first chronic phase (CML-CP1) receiving HLA-identical sibling donor (ISD) hematopoietic SCT (HSCT) or imatinib, a cross-sectional study that was part of a prospective cohort study at the Institute of Hematology, Peking University was performed. A total of 222 patients including 126 and 96 in the imatinib and ISD HSCT groups, respectively, were enrolled. HRQOL was measured using the Medical Outcomes Study 36-Item Short-Form Health Survey. The ISD HSCT group functioned significantly better on the role-physical functioning and mental health subscales, as well as the mental component summary (MCS) than the imatinib group. HRQOL was generally comparable to groups in the young population. Multivariate analysis showed that white blood cell count ≥ 30 × 10(9)/L and plts count ≥ 450 × 10(9)/L were the major adverse factors affecting HRQOL in long-term survivors. Imatinib therapy was also an adverse factor affecting the MCS (odds ratio=1.7, P=0.032). Thus, long-term CML-CP1 survivors receiving ISD HSCT can attain desirable HRQOL comparable to or better than that of patients receiving imatinib.
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Affiliation(s)
- X-D Mo
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Q Jiang
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - L-P Xu
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - D-H Liu
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - K-Y Liu
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - B Jiang
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - H Jiang
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - H Chen
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Y-H Chen
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - X-H Zhang
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - W Han
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Y Wang
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - X-J Huang
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
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