Challenges in management of older patients with chronic myeloid leukemia

Abstract

Tyrosine kinase inhibitors (TKIs) have significantly improved the survival of patients with chronic myeloid leukemia (CML), however, older patients are often underrepresented in pivotal trials. Approximately 20% of older adults never start treatment and face significant barriers to accomplish favorable outcomes. The treatment goal is to improve survival, prevent progression, and preserve quality of life. This is achieved through optimizing TKI doses and employing discontinuation strategies to attain treatment-free remission (TFR), a goal increasingly pursued by older patients. Imatinib may be favored as the front-line option for older individuals due to its side effect profile and cost. Bosutinib’s favorable cardiovascular tolerability makes it a suitable second-line agent, but lower-dose dasatinib may likewise be an attractive option. The prevalence of comorbidities can preclude the use of second generation TKIs in some older patients. Optimal care for older patients with CML centers on personalized treatment, close monitoring, and proactive support.

Keywords:

• Chronic myeloid leukemia
• older patients
• tyrosine kinase inhibitors
• treatment efficacy
• dose-reduction strategies

Disclosure statement

RMS reports consultancy fees from Bristol Myers Squibb, Gilead Sciences, Servier, Rigel, Kura Oncology, and Curio Science. NAP reports consultancy fees from Blueprint Medicines, Incyte, Novartis, PharmaEssentia, CTI BioPharma/Sobi, Constellation Pharmaceuticals/MorphoSys, AbbVie, Aptose Biosciences, and other financial support for serving on an Independent Data Review Committee for Cogent Biosciences.

Additional information

Funding

JMS is supported by NCI/NIH T32 CA233414.