Diabetic Patients With Newly Diagnosed Chronic Myeloid Leukemia: TKI Choice and Early Adverse Events. A Real-Life...

Limited data are available regarding patients with newly diagnosed chronic myeloid leukemia (CML) and concomitant diabetes mellitus (DM). Hence, we retrospectively analyzed 2149 patients with newly diagnosed chronic phase (CP) CML to compare clinical characteristics, choice of frontline therapy, early adverse events, and molecular responses between patients with or without DM. Among this cohort of 2149 patients, 241 patients (11.2%) had DM at CML diagnosis. Diabetic patients were older (median age 69.6 vs. 58.2 years, p < 0.001), showed a higher Sokal/ELTS risk and had more comorbidities, resulting in more frequent polypharmacy. Imatinib was frequently selected as first-line treatment in diabetic patients (71% vs. 53%, p < 0.001), whereas nilotinib was more common in nondiabetics (6.2% vs. 31.9%). Discontinuation by the 12th month occurred in 24.2% of diabetic patients versus 19.4% of nondiabetics (p = 0.031), mainly for hematologic toxicity. Diabetic patients showed a lower incidence of major molecular response (MMR) at the 12th month (55.9% vs. 68.1%, p = 0.002). Among diabetic patients, a trend toward better molecular responses was observed in patients receiving metformin (p = 0.068). In conclusion, DM represents a clinically meaningful comorbidity in newly diagnosed CML-CP, and seems to define a subgroup with distinct features, influencing both treatment decisions and early outcomes.