Chronic Myeloid Leukemia: Long-Term Outcome Data in the Imatinib Era
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Recent reports suggest that in the TKI era, the survival of chronic myeloid leukemia approaches that of general population. The real-world situation may be different. We analyzed patients (≥ 18 years) with chronic phase (CP) CML enrolled over a 7-year period (2002–2008) in an imatinib access program. Event was defined as non-achievement/loss of complete hematological response (CHR), loss of cytogenetic response or progression to accelerated (AP)/blast phase (BC). Progression was defined as development of AP/BC. Any delay of ≥ 1 week in reporting for drug refills was categorized as non-adherence. Of the 443 patients with CP-CML who started imatinib [median age: 36 years (18–70); High risk: 32% (Sokal) and 14% (Hasford/EUTOS)], 162 (37%) had received prior therapy [mostly hydroxyurea (N = 153]. CHR was achieved by 430 (97%). After a median follow up of 109.5 months (3.4–184.3), the EFS, PFS and OS at 10 years was 43%, 75% and 76% respectively. Superior EFS was predicted by low-risk Hasford score and adherence to therapy. Adherence to therapy was the only factor which predicted EFS on multivariate analysis (HR 0.64, 95% CI 0.50–0.83, P = 0.001). Long-term follow up of patients with CP-CML reflects poorer survival than those reported from clinical trials and reflects multiple issues that affect “real-world” patients. The continued drop in EFS, noted during long-term follow up, might take time to impact the PFS and OS due to the chronic nature of the disease. Sustained adherence to therapy is important for optimum long-term outcomes.
KeywordsChronic myeloid leukemia Imatinib Long-term outcomes 10-Year survival Adherence
We acknowledge the support from the Glivec International Patient Assistance Program and the Tamilnadu Government Insurance Scheme for supporting the medication for the patients. We thank Ms Tamilselvarani and Ms Vanitha N for helping patient coordination and data collection.
Conceptualization, data curation, investigation: all authors. Manuscript writing: PG, NM, JPK, TSG. Supervision and resources: PG, TGS.
The study was supported by Cancer Institute (WIA) funds. No grant number is applicable.
Compliance with Ethical Standards
Conflict of interest
None of the authors have any relevant conflicts of interests to declare.
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