Outcomes of Chronic Phase Chronic Myeloid Leukemia after Treatment with Multiple Tyrosine Kinase Inhibitors

• Type of Material: Article
• Authors: Jee Kong, Emory University; Elliott Winton, Emory University; Leonard T. Heffner, Emory University; Manila Gaddh, Emory University; Brittany Hill, Emory University; Jessica Neely, Emory University; Angela Hatcher, Emory University; Meena Joseph, Emory University; Martha Arellano, Emory University; Fuad El-Rassi, Emory University; Audrey Kim, Emory University; H Jean Khoury, Emory University; Vamsi Kota, Emory University
• Language: English
• Date: 2020-05-20
• Publisher: MDPI AG
• Publication Version: Final Published Version
• Copyright Statement: © 2020 by the authors.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3390/jcm9051542
• Title of Journal or Parent Work: Journal of Clinical Medicine
• Volume: 9
• Issue: 5
• Grant/Funding Information: This research received no external funding.
• Keywords: tyrosine kinase inhibitor; chronic myeloid leukemia; chronic phase; treatment-free remission; survival rates
• Research Categories: Health Sciences, Health Care Management; Health Sciences, Rehabilitation and Therapy; Health Sciences, Oncology; Chemistry, Pharmaceutical

Abstract

We sought to evaluate the outcomes of chronic phase (CP) chronic myeloid leukemia (CML) in an era where five tyrosine kinase inhibitors (TKIs) are commercially available for the treatment of CML. Records of patients diagnosed with CP CML, treated with TKIs and referred to our center were reviewed. Between January 2005 and April 2016, 206 patients were followed for a median of 48.8 (1.4–190.1) months. A total of 76 (37%) patients received one TKI, 73 (35%) received two TKIs and 57 (28%) were exposed to >3 TKIs (3 TKIs, n = 33; 4 TKIs, n = 17; 5 TKIs, n = 7). Nineteen (9.2%) patients progressed to advanced phases of CML (accelerated phase, n = 6; myeloid blastic phase, n = 4; lymphoid blastic phase, n = 9). One third (n = 69) achieved complete molecular response (CMR) at first-line treatment. An additional 55 patients achieved CMR after second-line treatment. Twenty-five patients (12.1%) attempted TKI discontinuation and 14 (6.8%) stopped TKIs for a median of 6.3 months (range 1–53.4). The 10-year progression-free survival and overall survival (OS) rates were 81% and 87%, respectively. OS after 10-years, based on TKI exposure, was 100% (1 TKI), 82% (2 TKIs), 87% (3 TKIs), 75% (4 TKIs) and 55% (5 TKIs). The best OS was observed in patients tolerating and responding to first line TKI, but multiple TKIs led patients to gain treatment-free remission.