Severe Adverse Events By First Line Tyrosine Kinase Inhibitors Decrease Survival Rate in Patients with Newly Diagnosed Chronic Phase Chronic Myeloid Leukemia

• Published in: Blood 2016-12, Vol.128 (22), p.1898-1898
• Main Authors: Ota, Shuichi, Matsukawa, Toshihiro, Yamamoto, Satoshi, Ito, Shinichi, Shindo, Motohiro, Sato, Kazuya, Kondo, Takeshi, Takahashi, Tohru, Sato, Tsutomu, Kakinoki, Yasutaka, Kobayashi, Hajime, Kurosawa, Mitsutoshi
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood.V128.22.1898.1898

Background: Chronic phase chronic myeloid leukemia (CML-CP) has become a manageable disease for most patients treated with tyrosine kinase inhibitors (TKIs). However, all TKIs have broad spectrum of toxic effects, and have to be managed by cessation, reduction and supportive care. The objective of this study is to analyze the adverse events (AEs) with different TKIs used as initial therapy for CML and their impact on outcome. Methods: We retrospectively evaluated a total of 494 patients with CML who received at least one TKI, imatinib, dasatinib, nilotinib and bosutinib in a practice setting between 2004 and 2014 at multicenter participating in the Hokkaido hematology study group. Results: Of the 494 patients (315 males and 179 females), with a median age of 59.5 years (range 2-93), imatinib, dasatinib or nilotinib were prescribed as the first line TKI in 283 (62.3%), 109 (24%) and 102 (22.5%) patients, respectively. Disease status at primary diagnosis was composed of chronic phase (450), accelerated phase (21) and blastic phase (23). With a median follow-up of 4.7 years in patients with CML-CP, the 5-year overall survival (OS), event-free survival (EFS) were 94.5% and 92.3%, respectively. The patients with complication or organ dysfunction (61/450, 13.6%) and age >60 (227/450, 50.4%) at diagnosis had significantly inferior OS (p= 0.0089 and p= 0.0012). The patients achieved higher rates of major molecular response (MMR) at 6 and 12 months after initial treatment with dasatinib, nilotinib vs imatinib (41.5%, 42.6% vs 12.5% and 54.3%, 54.5% vs 41.5%, p