Efficacy And Safety Of Imatinib Treatment In Elderly Patients With Chronic Myeloid Leukemia: Real-Life Data And A Single-Center Experience

We retrospectively compared the efficacy and safety of frontline imatinib between elderly patients (>= 60 years old) and younger patients ( <60 years old) with chronic myeloid leukemia (CML). Response rates were similar in both groups. Event-free survival was comparable, and overall survival-when non-CML-related deaths were censored-was also similar. Age at diagnosis and the Charlson comorbidity index were significantly associated with overall survival. In the era of tyrosine kinase inhibitors, survival of patients with CML is determined more by comorbidities than by the disease itself.Background: In the era of tyrosine kinase inhibitors (TKIs), chronic myeloid leukemia (CML) patients generally live close to a normal lifespan, and the number of elderly patients with CML with comorbidities is increasing. Patients and Methods: We retrospectively compared the efficacy and safety of frontline imatinib between elderly patients (>= 60 years old) and younger patients (<60 years old) with CML. Results: The study included 33 elderly and 125 younger patients. Elderly patients had significantly higher Charlson comorbidity index (CCI) scores. Efficacy and toxicity were comparable among the older patients with CCI scores of 0 and >= 1. There were significantly more hematologic adverse events (AEs) in elderly patients (P=.005). Although not significant, nonhematologic AEs were also more common in older cases (P=.056). Elderly patients had significantly higher rates of imatinib dose reduction (P<.001). Cumulative response rates were similar in both groups. Event-free survival was comparable, and overall survival (OS)-when non-CML-related deaths were censored-was also similar. In the multivariate analysis, age at diagnosis and CCI were associated with OS, and patients >= 60 years of age had a 5.998-times higher risk of death compared with the patients < 60 years of age (P=.011). Similarly, patients with CCI scores >= 2 had a 3.758-times higher risk of death compared with patients with a CCI score of 0 (P=.033). Conclusions: Upfront imatinib was generally well tolerated among elderly Turkish patients with CML with non-inferior responses and long-term outcomes when compared with younger patients. Comorbidities can be problematic in elderly patients, and today the survival of patients with CML is determined mostly by comorbidities. (C) 2021 Elsevier Inc. All rights reserved.