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Trends in Primary Treatment and Survival Among Elderly Patients With CML

By: Anna Nowogrodzki
Posted: Wednesday, July 15, 2020

Relative survival increased significantly between 1989 and 2017 among patients in the Netherlands with chronic myeloid leukemia (CML) aged 70 and older, likely because of increased use of tyrosine kinase inhibitors (TKIs), according to a recent population-based study. Avinash G. Dinmohamed, PhD, of the Netherlands Comprehensive Cancer Organisation, and colleagues published their findings in the journal Leukemia.

“Patients diagnosed in 2009–2017 had 63% lower excess mortality, as compared with patients diagnosed in 2001–2008,” wrote the authors.

The authors studied 1,525 patients who were 70 years and older with CML diagnosed between 1989 and 2017 in the national Netherlands Cancer Registry. The authors followed their survival through January 1, 2019. Male patients comprised 56% of the study. A total of 31% of patients were between 70 and 74 years old, 32% of patients were between 75 and 79, 22% of patients were between 80 and 84, and 15% of patients were 85 years or older.

The researchers analyzed patients’ relative survival during three time periods: 1989–2000 (before TKIs), 2001–2008 (when imatinib was available), and 2009–2017 (when second-generation TKIs were available). They calculated relative survival as overall survival divided by “expected survival of a comparable group from the general population, matched to the patients through age, sex, and period.” 

Although 1-year, 3-year, and 5-year relative survival improved significantly from 1989 to 2017 for all age groups, the timing of this improvement varied by age. Patients between the ages of 70 and 74 showed the greatest improvement in relative survival between the first and second time periods (when imatinib became available). Patients aged 75 and older—and especially those 85 and older—showed less improvement when imatinib was first available yet more improvement between the second and third time periods. “Physicians were possibly reticent to offer tyrosine kinase inhibitors to elderly, often comorbid patients—especially in the early years,” wrote the authors. 

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



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