Many patients with chronic myeloid leukemia (CML) do not receive adequate, guideline-recommended therapy, including not receiving any therapy with tyrosine kinase inhibitors (TKIs) and not receiving recommended daily doses, study findings published in the European Journal of Haematology has shown.
Lifelong, daily treatment with TKIs has established efficacy in CML and is safe across age groups, including the elderly. Additionally, adhering to guideline-compliant daily use is associated with improved clinical outcomes. Furthermore, regular molecular and cytogenetic monitoring of the disease can improve clinical outcomes and is guideline-recommended.
In this study, researchers assessed data from health codes and prescribed medications from the Bavarian Association of Statutory Health Insurance Physicians, a German statutory health insurance system, between 2010 and 2016. Recommended doses of TKIs were based on approved doses from the European Medicines Agency, which is based on recommended doses from the European LeukemiaNet (ELN). Information on molecular and cytogenetic monitoring came from Munich Leukemia Laboratory (MLL).
Of 1714 adult patients with CML, only slightly more than half (50.8%) received more than 67.5 daily doses per quarter year of TKIs, far below the guideline-recommended target of 91.5. Nearly 1 in 5 patients (18.2%) did not receive any TKIs.
Even though previous research indicates TKIs are safe and efficacious across age groups, the percentage of patients who did not receive any TKIs increased with age. In patients between 20 and 59 years, 9% of males and 14% of females did not receive any TKIs. This increased to 17% of males and 19% of females between ages 60 and 69 years, 24% of males and 25% of females between ages 70 and 79 years, and 31% of males and 41% of females aged 80 years and older.
ELN recommends PCRs every 3 months until major molecular response (MMR) and every 3 to 6 months after MMR. Cytogenetic analysis every 3 to 6 months until complete cytogenetic remission should be followed by analysis once per year. Based on data from 2104 patients from MLL, the median number of molecular assessments was 3.54, which was independent of age and sex. Rate of molecular analysis remained constant across patient age, but rate of cytogenetic analysis decreased as age increased.
The authors concluded by noting that physicians and patients need to emphasize dose compliance with TKIs.
- Lauseker M, Gerlach R, Worseg W, et al. Differences in treatment and monitoring of chronic myeloid leukemia with regard to age, but not sex: results from a population-based study [published online July 15, 2019]. Eur J Haematol. doi: 10.1111/ejh.13293