Age influences initial dose and compliance to imatinib in chronic myeloid leukemia elderly patients but concomitant comorbidities appear to influence overall and event-free survival

作者：Breccia Massimo^*; Luciano Luigiana; Latagliata Roberto; Castagnetti Fausto; Ferrero Dario; Cavazzini Francesco; Trawinska Malgorzata Monica; Annunziata Mario; Stagno Fabio; Tiribelli Mario; Binotto Gianni; Crisa Elena; Musto Pellegrino; Gozzini Antonella; Cavalli Laura; Montefusco Enrico; Iurlo Alessandra; Russo Sabina; Cedrone Michele; Rossi Antonella Russo; Pregno Patrizia; Endri Mauro; Spadea Antonio; Molica Matteo; Giglio Gianfranco; Celesti Francesca

来源：Leukemia Research, 2014, 38(10): 1173-1176.

DOI：10.1016/j.jeukres.2014.06.020

• Chronic myeloid leukemia
• Age
• Comorbidities
• Overall survival

We applied Charlson comorbidity index (CCI) stratification on a large cohort of chronic myeloid leukemia (CML) very elderly patients (%26gt;75 years) treated with imatinib, in order to observe the impact of concomitant diseases on both compliance and outcome. One hundred and eighty-one patients were recruited by 21 Italian centers. There were 95 males and 86 females, median age 78.6 years (range 75-93.6). According to Sokal score, 106 patients were classified as intermediate risk and 55 as high risk (not available in 20 patients). According to CCI stratification, 71 patients had score 0 and 110 a score %26gt;= 1. Imatinib standard dose was reduced at start of therapy (200-300 mg/day) in 68 patients independently from the evaluation of baseline comorbidities, but based only on physician judgement: 43.6% of these patients had score 0 compared to 34% of patients who had score %26gt;= 1. Significant differences were found in terms of subsequent dose reduction (39% of patients with score 0 compared to 53% of patients with score %26gt;= 1) and in terms of drug discontinuation due to toxicity (35% of patients with score 0 vs 65% of patients with score %26gt;= 1). We did not find significant differences as regards occurrence of hematologic side effects, probably as a consequence of the initial dose reduction: 39% of patients with score 0 experienced grade 314 hematologic toxicity (most commonly anemia) compared to 42% of patients with score %26gt;= 1. Independently from the initial dose, comorbidities again did not have an impact on development of grade 314 non-hematologic side effects (most commonly skin rash, muscle cramps and fluid retention): 62% of patients with score 0 compared to 52.5% of patients with score %26gt;= 1. Notwithstanding the reduced dose and the weight of comorbidities we did not find significant differences but only a trend in terms of efficacy: 66% of patients with score 0 achieved a CCyR compared to 54% of patients with score %26gt;= 1. Comorbidities appeared to have an impact on median OS (40.8 months for patients with score 0 vs 20.16 months for patients with score %26gt;= 1) on EFS and on non-CML death rate. Our results suggest that treatment of very elderly CML patients might be influenced by personal physician perception: evaluation at baseline of comorbidities according to CCI should improve initial decision-making in this subset of patients.

• 出版日期2014-10