Long term follow-up of frontline Dasatinib in older patients with chronic myeloid leukemia in chronic phase treated outside clinical trials: a real-life cohort observational study

Abstract

Background

A limited amount of data has been published in chronic-phase chronic myeloid leukemia (CP-CML) patients aged >75 years treated frontline with second-generation tyrosine kinase inhibitors.

Aims

To address this issue in a clinical ‘real-life’ setting, we retrospectively analyzed 45 CP-CML patients (pts) followed in 20 Italian Centers and treated frontline with dasatinib (DAS).

Patients and methods

Median age was 78.4 years (range 75–89.2 years). DAS starting dose was 100 mg QD in 35 pts (77.7%), 80 mg QD in 1 pts (2.2%) and 50 mg QD in 9 pts (20.1%), respectively. The median follow-up was 42.6 months (IQR 20.4 − 63.3).

Results

Grade 3 and 4 side effects, both hematological and non-hematological, were detected in 6 (13.3%) and 12 (26.6%) pts, respectively. Pleural effusions of all grades occurred in 13 pts (28.8%) after a median period of DAS exposure of 14.7 months (IQR 3.0 − 33.1). The rates of DAS dose reduction and permanent drug discontinuation were 53.3% and 20.0%, respectively. As the best response, 42/45 patients (93.3%) achieved a complete cytogenetic response (CCyR), 35/45 (77.7%) a major molecular response (MMR) and 24/45 (53.3%) a deep molecular response (both MR 4.0 and MR 4.5). Only 1 patient (2.2%) progressed to the blast phase after 13 months of therapy; 8 deaths were observed (1 CML-related and 7 CML-unrelated). Cumulative event-free survival and overall survival at 36 months were 64.7% (95%, CI 49.4 − 80.0) and 82.3% (95%, CI 70.3–94.3), respectively.

Conclusion

These findings, although evaluated in a limited and selected cohort of patients, suggest that DAS might be effective in older patients (aged >75 years) affected by CP-CML with acceptable toxicity.

Keywords:

• Chronic myeloid leukemia
• dasatinib
• imatinib
• nilotinib
• CML therapy
• older CML patients

Disclosure statement

These Authors declare the following conflict of interest: FS: honoraria by Bristol Myers-Squibb, Incyte, Novartis, Pfizer; FDR: honoraria by Amgen, Bristol Myers-Squibb, Celgene, Incyte, Novartis, Pfizer. MBr: honoraria by Novartis, Pfizer, Incyte, BMS/Celgene, AbbVie; MBo: honoraria by Amgen, Bristol Myers Squibb/Celgene, Incyte, Novartis, Pfizer, GG: honoraria by Novartis, Incyte, Pfizer; GR honoraria by Bristol Myers Squibb/Celgene, Novartis, Pfizer, Incyte; EA: honoraria by Bristol Myers Squibb/Celgene, Novartis, Incyte, Pfizer; AI honoraria by Novartis, Bristol Myers Squibb/Celgene, Pfizer, Incyte; MT: honoraria by Bristol Myers Squibb/Celgene, Novartis, Pfizer, Incyte. MC: honoraria by Novartis. All other authors have no potential conflict of interests regarding the article.