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Changes in chronic myeloid leukemia treatment modalities and outcomes after introduction of second-generation tyrosine kinase inhibitors as first-line therapy: a multi-institutional retrospective study by the CML Cooperative Study Group

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Abstract

This study investigated changes in treatment modalities and outcomes of chronic myeloid leukemia in the chronic phase (CP-CML) after the approval of second-generation tyrosine kinase inhibitors (2G-TKIs) for first-line therapy. Patients were grouped into those who underwent TKI therapy up to December 2010 (imatinib era group, n = 185) and after January 2011 (2G-TKI era group, n = 425). All patients in the imatinib era group were initially treated with imatinib, whereas patients in the 2G-TKI era group were mostly treated with dasatinib (55%) or nilotinib (36%). However, outcomes including progression-free survival, overall survival, and CML-related death (CRD) did not differ significantly between groups. When stratified by risk scores, the prognostic performance of the ELTS score was superior to that of the Sokal score. Even though both scoring systems predicted CRD in the imatinib era, only the ELTS score predicted CRD in the 2G-TKI era. Notably, the outcome of patients classified as high-risk by ELTS score was more favorable in the 2G-TKI era group than in the imatinib era group. Thus, expanding treatment options may have improved patient outcomes in CP-CML, particularly in patients classified as high-risk by ELTS score.

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Authors and Affiliations

  1. Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan

    Noriyoshi Iriyama & Yoshihiro Hatta

  2. Department of Hematology, Rheumatology and Infectious Diseases, Kumamoto University Hospital, Kumamoto, Japan

    Eisaku Iwanaga & Tatsuya Kawaguchi

  3. Department of Hematology, Japan Community Health Care Organization, Saitama Medical Center, Saitama, Japan

    Yuta Kimura & Michihide Tokuhira

  4. Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan

    Naoki Watanabe, Tomoiku Takaku & Miki Ando

  5. Department of Hemato-Oncology, Saitama Medical University International Medical Center, Saitama, Japan

    Maho Ishikawa

  6. Department of Hematology, Yokohama Municipal Citizen’s Hospital, Yokohama, Japan

    Hitomi Nakayama & Tomonori Nakazato

  7. Department of Hematology, Juntendo University Nerima Hospital, Tokyo, Japan

    Eriko Sato

  8. Department of Hematology, Saitama Medical Center, Saitama Medical University, Saitama, Japan

    Takayuki Tabayashi

  9. Department of Hematology, Juntendo University Urayasu Hospital, Urayasu, Japan

    Toru Mitsumori

  10. Department of Hematology, Saiseikai Yokohama Nanbu Hospital, Yokohama, Japan

    Hiroyuki Fujita

  11. Department of Medical Technology, Kumamoto Health Science University, Kumamoto, Japan

    Tatsuya Kawaguchi

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  1. Noriyoshi Iriyama
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  2. Eisaku Iwanaga
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Contributions

N.I., E.I., M.I., T.N., E.S., T(Tomoiku).T., M.T., H.F., M.A., Y.H., and T.K. contributed to the conception of the work. N.I., E.I., Y.K., N.W., M.I., H.N., T.N., E.S., T(Takayuki).T., T.M., T(Tomoiku).T., M.T., H.F., and T.K. accumulated patient data. N.I. analyzed data and wrote the manuscript, and all other authors revised and interpretation of the study results. Finally, all authors agreed and gave final approval of the manuscript for submission.

Corresponding author

Correspondence to Noriyoshi Iriyama.

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Conflict of interest

N.I. received honoraria and speaker fees from Bristol-Myers Squibb, Novartis Pharma K.K., Otsuka Pharmaceutical and Pfizer Inc. E.I. received honoraria from Bristol-Myers Squibb, Novartis Pharma K.K. and Otsuka Pharmaceutical. M.T. received honoraria and speaker fees from Pfizer Inc. and Bristol-Myers Squibb. T(Tomoiku).T. and Y.H. received honoraria from Bristol-Myers Squibb and Novartis Pharma K.K. T.K. received honoraria and speaker fees from Bristol-Myers Squibb, Novartis Pharma K.K. and Pfizer Inc. The remaining authors declare no competing financial interests to declare.

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12185_2024_3758_MOESM1_ESM.jpg

Supplementary Figure 1. Prognostic predictability of ELTS score in patients initially treated with second-generation tyrosine kinase inhibitors. The event-free survival (EFS, A), progression-free survival (PFS, B), overall survival (OS, C), and chronic myeloid leukemia-related death (CRD, D) were stratified according to ELTS score (low, n = 260; intermediate, n = 97; high, n = 14). Supplementary file1 (JPG 390 KB)

Supplementary file2 (DOCX 27 KB)

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Iriyama, N., Iwanaga, E., Kimura, Y. et al. Changes in chronic myeloid leukemia treatment modalities and outcomes after introduction of second-generation tyrosine kinase inhibitors as first-line therapy: a multi-institutional retrospective study by the CML Cooperative Study Group. Int J Hematol (2024). https://doi.org/10.1007/s12185-024-03758-4

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