Current and emerging tyrosine kinase inhibitors for the treatment of chronic myeloid leukemia in young adults

ABSTRACT

Introduction

Chronic myeloid leukemia (CML) is more common in older adults, but nearly 15–20% of the patients is between 15 and 39 years of age. In this age group, patients may seek clinical care a much later period of the disease and they may have a heavier burden of disease. In addition, young patients with CML may face unique challenges related to their age, such as concerns about health care, fertility, or careers. The current standard of care for CML is the use of tyrosine kinase inhibitors (TKIs), which induce remission in most young patients and can achieve long-term disease control.

Areas covered

This review summarizes age-specific treatment-related conditions, as well as the effectiveness of TKI therapy in this age group. PubMed, Google Scholar, clinicaltrials.gov and other abstract databases were used while preparing this review. The period of 2001–2023 was chosen as the search window.

Expert opinion

Although we do not have sufficient data, young adult population has a special importance for TKI treatment. Clinical features, efficacy of treatments, and specific conditions in this age group should attract more attention of clinicians and more intensive studies should be conducted in the future.

KEYWORDS:

• Age
• AYA
• chronic myeloid leukemia
• CML
• tyrosine kinase inhibitors
• TKI
• young adults

Article highlights

• Young adult patients make up 15–20% of the CML population. Conditions associated with disease burdens, such as splenomegaly, leukocytosis, or anemia are more severe in this patient group.

• Although imatinib is an appropriate treatment in low-risk patients, initiating treatment with second-generation TKIs may be a more appropriate option in patients where possible. If there is no rapid response in patients who are started on treatment with imatinib, care should be taken to change the treatment when needed.

• Adherence with treatment in this young patient group is lower than other patients, and physician-patient cooperation is needed to solve this problem.

• Studies on TKIs, such as bosutinib, ponatinib, and ascimimib based on comparing young patient population with older ones are needed.

• TKI therapy should be discontinued appropriately in pregnant women. Alternative treatments should be given to necessary patients. For women who have pregnancy desire, the patients should be informed that the periods during which the deep response is as long as possible are appropriate.

Declaration of interest

A E Eşkazan has received advisory board and speaker bureau honoraria from Novartis, Bristol-Myers Squibb, and Pfizer, outside the present study.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.