Outcomes of Chronic Phase Chronic Myeloid Leukemia after Treatment with Multiple Tyrosine Kinase Inhibitors

We sought to evaluate the outcomes of chronic phase (CP) chronic myeloid leukemia (CML) in an era where five tyrosine kinase inhibitors (TKIs) are commercially available for the treatment of CML. Records of patients diagnosed with CP CML, treated with TKIs and referred to our center were reviewed. B...

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Published inJournal of clinical medicine Vol. 9; no. 5; p. 1542
Main Authors Kong, Jee Hyun, Winton, Elliott F, Heffner, Leonard T, Gaddh, Manila, Hill, Brittany, Neely, Jessica, Hatcher, Angela, Joseph, Meena, Arellano, Martha, El-Rassi, Fuad, Kim, Audrey, Khoury, Jean Hanna, Kota, Vamsi K
Format Journal Article
LanguageEnglish
Published Switzerland MDPI AG 20.05.2020
MDPI
Subjects
Bone marrow
Chemotherapy
Clinical medicine
Clinical trials
Kinases
Leukemia
Mutation
Stem cells
United States > US
chronic myeloid leukemia
chronic phase
tyrosine kinase inhibitor
survival rates
treatment-free remission
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Summary:We sought to evaluate the outcomes of chronic phase (CP) chronic myeloid leukemia (CML) in an era where five tyrosine kinase inhibitors (TKIs) are commercially available for the treatment of CML. Records of patients diagnosed with CP CML, treated with TKIs and referred to our center were reviewed. Between January 2005 and April 2016, 206 patients were followed for a median of 48.8 (1.4-190.1) months. A total of 76 (37%) patients received one TKI, 73 (35%) received two TKIs and 57 (28%) were exposed to >3 TKIs (3 TKIs, = 33; 4 TKIs, = 17; 5 TKIs, = 7). Nineteen (9.2%) patients progressed to advanced phases of CML (accelerated phase, = 6; myeloid blastic phase, = 4; lymphoid blastic phase, = 9). One third ( = 69) achieved complete molecular response (CMR) at first-line treatment. An additional 55 patients achieved CMR after second-line treatment. Twenty-five patients (12.1%) attempted TKI discontinuation and 14 (6.8%) stopped TKIs for a median of 6.3 months (range 1-53.4). The 10-year progression-free survival and overall survival (OS) rates were 81% and 87%, respectively. OS after 10-years, based on TKI exposure, was 100% (1 TKI), 82% (2 TKIs), 87% (3 TKIs), 75% (4 TKIs) and 55% (5 TKIs). The best OS was observed in patients tolerating and responding to first line TKI, but multiple TKIs led patients to gain treatment-free remission.
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In memoriam.
ISSN:2077-0383
2077-0383
DOI:10.3390/jcm9051542