Abstract
Very elderly (> 75 years) chronic myeloid leukaemia (CML) patients at diagnosis are sometimes treated with different doses of imatinib (IM) based on concomitant diseases and physicians’ judgement. However, data on long-term follow-up of these patients are still lacking. To investigate treatment response and outcome, we retrospectively revised an Italian database of 263 very elderly CML patients receiving IM from the time of diagnosis. Median age at diagnosis was 78.5 years and 56% of patients had 2 or 3 comorbidities. A complete haematological and cytogenetic response were achieved in 244 (92.8%) and 184 (69.9%) patients, respectively. In 148 cases (56.2%), a major molecular response was observed, which was deep in 63 cases (24%). A blastic phase occurred in 11 patients (4.2%). After a median follow-up of 45.0 months, 93 patients have died (9 from disease progression) and 104 (39.5%) are still in treatment with IM. Incidence of grades 3–4 haematological and non-haematological toxicity was similar to those reported in younger patients. Five-year event-free survival was 54.5% and 45.2% in patients ≤ 80 years and > 80 years, respectively (p = 0.098). Five years OS was 75.7% and 61.6% in patients ≤80 years and > 80 years, respectively (p = 0.003). These findings show that IM plays an important role in frontline treatment of very elderly CML patients without increased toxicity and any effort to treat these patients with standard doses should be made in order to achieve responses as in younger subjects.
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Monica Crugnola, Fausto Castagnetti, Massimo Breccia, Elisabetta Abruzzese, Gabriele Gugliotta, and Fabio Stagno declare that they received speaker honorarium from Novartis, BMS, Incyte, Pfizer, Amgen. Massimiliano Bonifacio declares research funding from Novartis and speakers honorarium from BMS, Incyte, Pfizer. No conflict of interest has been declared from other authors. All procedure performed in this study were in accordance with ethical standards and with the Helsinki declaration. Informed consent was obtained from all individual participants included in this study.
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Crugnola, M., Castagnetti, F., Breccia, M. et al. Outcome of very elderly chronic myeloid leukaemia patients treated with imatinib frontline. Ann Hematol 98, 2329–2338 (2019). https://doi.org/10.1007/s00277-019-03767-y
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DOI: https://doi.org/10.1007/s00277-019-03767-y