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First-Line Imatinib Dosing in Elderly Patients With CML

By: Melissa E. Fryman, MS
Posted: Monday, July 29, 2019

A sustained daily dosage of 400 mg of imatinib for patients with chronic myeloid leukemia (CML) seems to achieve optimal clinical responses, irrespective of age, according to Petra Belohlavkova, PhD, of the University Hospital and Charles University, Hradec Kralove, Czech Republic, and colleagues. Their study results were published in Leukemia Research. 

In this retrospective study, the data on 372 patients with CML from the CAMELIA registry, being treated with first-line imatinib, were analyzed. Of them, 80 patients older than age 65 were compared with 292 younger patients in two different analyses: analysis A (with all patients younger than age 65), or analysis B (with separate analyses of younger and older adult patients). The median follow-up was 82.3 months.

Despite higher prognostic risk scores, and occasional lower imatinib doses, in older relative to younger CML patients, no significant difference was found in terms of complete hematologic response, complete cytogenetic response at 6 or 12 months, major molecular response at 18 months, or time to achieving therapeutic responses.

The 10-year rate of overall survival for patients younger than age 40, between ages 40 and 64, and older than age 65 was 90.6%, 83.7%, and 68.1%, respectively (P < .001). Significant differences were also observed in terms of overall survival due to CML-related deaths (P = .027), and progression-free survival (P = .003), but not in terms of the rate of event-free survival (P = .351). The highest rates of overall survival due to CML-related deaths, progression-free survival, and event-free survival were experienced by patients on a sustained daily imatinib dose of 400 mg (P = .018, P = .011, and P = .001, respectively). Patients who received more than 400 mg of imatinib had the worst therapeutic responses.

“Elderly patients should be managed with the utmost care and with an effort to maintain a standard [imatinib] dosage,” the authors concluded.

Disclosure: The study authors’ disclosure information may be found at sciencedirect.com.



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