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Adolescents experienced more treatment failure than children with chronic myeloid leukemia receiving imatinib as frontline therapy: a retrospective multicenter study

Annals of Hematology volume 100, pages 2215–2228 (2021)Cite this article

Abstract

To explore the differences in the clinical features, treatment responses, and outcomes among children, adolescents, and adults with chronic myeloid leukemia in the chronic phase (CML-CP) receiving imatinib as first-line therapy. Data from children (0–8 years for girls and 0–10 years for boys), adolescents (9–19 years for girls and 11–19 years for boys), and adults (age ≥ 20 years) with newly diagnosed CML-CP receiving imatinib as first-line therapy between 2006 and 2019 were retrospectively reviewed. In total, 135 children (cohort 1), 189 adolescents (cohort 2), and 658 adults (cohort 3: age 20–39 years, n = 305; cohort 4: age 40–59 years, n = 270; and cohort 5: age 60–83 years, n = 83) were included in this study. When compared with children, adolescents showed a significantly higher white blood cell count (P = 0.033) and basophil percentage in peripheral blood (P = 0.002) and a significantly higher prevalence of splenomegaly (P = 0.004). Both children and adolescents presented with more aggressive clinical features than adults. During median follow-ups of 28 months (range, 3–161 months) in children, 33 months (range, 3–152 months) in adolescents, and 48 months (range, 3–157 months) in adults, multivariate analysis showed that children and adolescents had higher probabilities of achieving complete cytogenetic response, major molecular response, and molecular response4.5. Notably, compared with not only adults (cohort 3 vs. cohort 1: HR = 2.03 [1.03, 3.98], P = 0.040; cohort 4 vs. cohort 1: HR = 2.15 [1.07, 4.33], P = 0.033; cohort 5 vs. cohort 1: HR = 4.22 [1.94, 9.15], P < 0.001) but also adolescents (cohort 2 vs. cohort 1: HR = 2.36 [1.18, 4.72], P = 0.015), children had significantly longer failure-free survival. Age was not associated with progression-free survival or overall survival. Although they exhibited more aggressive clinical features at diagnosis, both children and adolescents achieved superior treatment responses than adults. Adolescents showed even more adverse features and a poor FFS than children.

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Acknowledgements

The authors would like to thank Professor Meinolf Suttorp who kindly reviewed the typescript and the American Journal Experts (www.journalexperts.com) that provided editorial assistance.

Funding

This study was funded by the National Natural Science Foundation of China (No. 81770161 and No. 81970140).

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    Authors and Affiliations

    1. Peking University People’s Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China

      Xuelin Dou & Qian Jiang

    2. Department of Pediatrics, Peking University People’s Hospital, Beijing, China

      Fangyuan Zheng, Yueping Jia & Leping Zhang

    3. Hematology and Oncology Center, Beijing Children’s Hospital Affiliated to Capital Medical University, Beijing, China

      Liqiang Zhang

    4. Department of Hematology, Zhejiang University First Affiliated Hospital, Zhejiang, China

      Jie Jin

    5. Department of Hematology, Henan Cancer Hospital, Henan, China

      Yanli Zhang

    6. Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China

      Bingcheng Liu & Xiaofan Zhu

    7. Department of Hematology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Hubei, China

      Li Meng

    8. Guangdong Provincial People’s Hospital, Guangdong Provincial Geriatrics Institute Guangzhou, Guangdong, China

      Zesheng Lu

    9. Department of Hematology, The First Affiliated Hospital of University of Science and Technology of China: Anhui Provincial Hospital, Anhui, China

      Huilan Liu

    10. Department of Hematology and Oncology, Jilin University First Hospital, Jilin, China

      Hai Lin

    11. Shanghai Institute of Hematology, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China

      Li Zhou

    12. Department of Hematology, Xiangya Hospital Central South University, Hunan, China

      Xielan Zhao

    13. Department of Hematology, Shengjing Hospital of China Medical University, Liaoning, China

      Wei Yang

    14. Department of Hematology, Zhengzhou University First Affiliated Hospital, Henan, China

      Hui Sun

    15. Department of Hematology, Nanjing Medical University Affiliated Nanjing Hospital: Nanjing First Hospital, Jiangsu, China

      Sixuan Qian

    16. Department of Hematology, The Third People’s Hospital of Zhengzhou, Henan, China

      Hongxia Ma

    17. Department of Hematology, Shenzhen Second People’s Hospital, Guangdong, China

      Xin Du

    18. Department of Hematology, Xijing Hospital, Shanxi, China

      Qingxian Bai

    19. Department of Hematology, Southern Medical University Nanfang Hospital, Guangdong, China

      Na Xu

    20. Department of Hematology, The Affiliated Hospital of Qingdao University, Shandong, China

      Fanjun Meng

    21. Department of Hematology, Liaoning, China

      Zhilin Jia

    22. Department of Hematology, Langfang Traditional Chinese Hospital, Hebei, China

      Haixia Di

    23. Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China

      Qian Jiang & Qian Jiang

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    Xuelin Dou, Fangyuan Zheng, and Liqiang Zhang contributed equally to this article

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    Dou, X., Zheng, F., Zhang, L. et al. Adolescents experienced more treatment failure than children with chronic myeloid leukemia receiving imatinib as frontline therapy: a retrospective multicenter study. Ann Hematol 100, 2215–2228 (2021). https://doi.org/10.1007/s00277-021-04544-6

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    Keywords

    • Chronic myeloid leukemia
    • Imatinib
    • Children
    • Adolescents