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Challenges in management of older patients with chronic myeloid leukemia

Jessica M Stempel1,2, Rory M Shallis1,2, Rong Wong2,3

  • 1Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.

Leukemia & Lymphoma
|April 23, 2024
PubMed

Insights

Older adults with chronic myeloid leukemia (CML) face treatment barriers. Optimizing tyrosine kinase inhibitor (TKI) doses and pursuing treatment-free remission (TFR) improves outcomes for elderly CML patients.

Area of Science:

  • Hematology
  • Geriatric Medicine
  • Pharmacology

Background:

  • Tyrosine kinase inhibitors (TKIs) have revolutionized chronic myeloid leukemia (CML) treatment, significantly improving patient survival.
  • Older adults are often underrepresented in clinical trials, leading to challenges in treatment optimization for this demographic.
  • A notable percentage of elderly patients do not initiate TKI therapy, encountering substantial obstacles to achieving favorable outcomes.

Purpose of the Study:

  • To review and summarize current strategies for optimizing TKI therapy in older adult patients with CML.
  • To discuss the potential of treatment-free remission (TFR) as a therapeutic goal for elderly CML patients.
  • To highlight considerations for selecting appropriate TKIs and managing comorbidities in geriatric CML care.

Main Methods:

  • Literature review of studies focusing on TKI treatment in older CML patients.
  • Analysis of treatment guidelines and clinical trial data concerning geriatric populations.
  • Evaluation of TKI efficacy, safety profiles, and discontinuation strategies in the context of aging.

Main Results:

  • Imatinib is often preferred as a first-line TKI for older adults due to its side effect profile and cost-effectiveness.
  • Bosutinib demonstrates favorable cardiovascular tolerability, positioning it as a potential second-line option, while lower-dose dasatinib is also considered.
  • Comorbidities in older patients may restrict the use of certain second-generation TKIs, necessitating individualized treatment approaches.

Conclusions:

  • Personalized treatment strategies, including dose optimization and TFR exploration, are crucial for improving survival and quality of life in older CML patients.
  • Careful selection of TKIs, considering drug interactions and patient comorbidities, is essential for effective management.
  • Proactive monitoring and supportive care are integral components of optimal CML management in the elderly population.
Keywords:
Chronic myeloid leukemiadose-reduction strategiesolder patientstreatment efficacytyrosine kinase inhibitors

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