scholarly journals Survival Among Minority Populations with Chronic Myeloid Leukemia: A Surveillance Epidemiology and End Results Database Analysis

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 3546-3546
Author(s):  
Owhofasa Agbedia ◽  
Julius Ngwa ◽  
Deepika S. Darbari ◽  
Patricia Oneal
Keyword(s):  
Chronic Myeloid Leukemia ◽  
American Indian ◽  
Alaska Native ◽  
Targeted Therapies ◽  
Myeloid Leukemia ◽  
The United States ◽  
Minority Populations ◽  
Hematopoietic Stem ◽  
End Results

Abstract Introduction: Cancer affects people of all races in the U.S.; however, the burden is greater for minority populations. This is influenced by factors such as demographics, behavioral factors, and access to medical services. The disparity is well documented in some solid tumors. However, little information exists on a racial disparity in survival among minority populations diagnosed with chronic myeloid leukemia (CML) especially in the era of targeted therapies. A better understanding of the population impact of CML will drive further research into approaches to improve overall outcomes. Methods: All cases of CML diagnosed between 1973 and 2017 and with available follow-up data reported in the Surveillance, Epidemiology, and End Results database were reviewed. We performed a population-based study of CML to evaluate survival by race and calendar year of diagnosis: 1975-1989 (the era of cytotoxic therapy; busulfan and hydroxyurea), 1990-2000 (the era of Allogeneic hematopoietic stem cell transplantation or interferon-alfa ± cytarabine), and 2001-2015 (the era of targeted therapy; Tyrosine Kinase Inhibitors). Results: A total of 14572 (56.4% were females) patients diagnosed with CML were included in our analysis. The racial distribution was 83.4% white, 10% black, 0.8% American Indian/Alaska Native and 5.9% Asian or Pacific Islander. 5314 (36.5%), 3725 (25.5%) and 5544 (38%) cases of CML were diagnosed during the 1975-1989, 1990-2000 and 2001-2015 eras respectively. The median 5-year survival improved by race with each era, with the greatest improvement observed among patients diagnosed during the 2001-2015 era. Although a trend of improvement in the median 5-year survival is seen across all age categories, patients 65 years and older continue to experience only a modest survival benefit in the era of targeted therapies (Table 1). No significant differences in survival by race was observed in the era of targeted therapies (Figure 1). Conclusions: This survival analysis includes a longer follow-up duration (Diagnosis Years: 1973-2015) for patients with CML compared to prior studies. Although an overall improvement in median survival is seen across all age groups and by each era, survival benefits are lagging in certain populations (black and American Indian/ Alaska Native) older than 65. SEER database captures information from metropolitan counties in the United States and this may not truly reflect the health of the entire US population. Disclosures No relevant conflicts of interest to declare.

Long-term follow-up of allogeneic hematopoietic stem-cell transplantation with reduced-intensity conditioning for patients with chronic myeloid leukemia

Blood ◽  
2007 ◽  
Vol 110 (9) ◽  
pp. 3456-3462 ◽  
Author(s):  
Partow Kebriaei ◽  
Michelle A. Detry ◽  
Sergio Giralt ◽  
Antonio Carrasco-Yalan ◽  
Athanasios Anagnostopoulos ◽  
...  
Keyword(s):  
Stem Cell ◽  
Chronic Myeloid Leukemia ◽  
Hematopoietic Stem Cell Transplantation ◽  
Myeloid Leukemia ◽  
Chronic Phase ◽  
Reduced Intensity Conditioning ◽  
Hematopoietic Stem ◽  
Reduced Intensity

Abstract Allogeneic hematopoietic stem-cell transplantation (HSCT) remains an effective strategy for inducing durable remission in chronic myeloid leukemia (CML). Reduced-intensity conditioning (RIC) regimens extend HSCT to older patients and those with comorbidities who would otherwise not be suitable candidates for HSCT. The long-term efficacy of this approach is not established. We evaluated outcomes of 64 CML patients with advanced-phase disease (80% beyond first chronic phase), not eligible for myeloablative preparative regimens due to older age or comorbid conditions, who were treated with fludarabine-based RIC regimens. Donor type was matched related (n =30), 1 antigen-mismatched related (n =4), or matched unrelated (n =30). With median follow-up of 7 years, overall survival (OS) and progression-free survival (PFS) were 33% and 20%, respectively, at 5 years. Incidence of treatment-related mortality (TRM) was 33%, 39%, and 48% at 100 days, and 2 and 5 years after HSCT, respectively. In multivariate analysis, only disease stage at time of HSCT was significantly predictive for both OS and PFS. RIC HSCT provides adequate disease control in chronic-phase CML patients, but alternative treatment strategies need to be explored in patients with advanced disease. TRM rates are acceptable in this high-risk population but increase over time.

Long-Term Follow-up Results Over 7 Years for Survival, and Safety with Imatinib Mesylate Accompany with Allogeneic Transplantation for Chronic Myeloid Leukemia

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4529-4529
Author(s):  
Jun Wang ◽  
Aining Sun ◽  
Wu Depei ◽  
Huiying Qiu ◽  
XiaoWen Tang
Keyword(s):  
Chronic Myeloid Leukemia ◽  
Imatinib Mesylate ◽  
Myeloid Leukemia ◽  
Conflicts Of Interest ◽  
Allogeneic Transplantation ◽  
Cytogenetic Response ◽  
Hematopoietic Stem ◽  
Long Term Follow Up

Abstract Abstract 4529 Objective: To observe the efficacy and safety of imatinib mesylate (IM) accompany with allogeneic transplantation for chronic myeloid leukemia (CML). Methods: During the period from January 2003 to August 2011,we retrospectively observed 95 patients with CML receiving IM for a minimum of 4 months before allogeneic hematopoietic stem cell transplantation (HSCT). Patients with advanced CML received IM from 3 month after transplantation for 12 months. Results: Among 95 enrolled patients (CML-CP 76, CML-AP 10, CML-BP 9), types of transplantation: sib-matched HSCT 64, unrelated-HSCT 19, haplo-HSCT 12. For the whole patients, 7 year overall survival (OS) is 80.5%, and disease free survival (DFS) is 74.5%. Complete hematologic response (CHR) is 93.6%, complete cytogenetic response (CCR) is 84.5%, major cytogenetic response (MCR) is 60.3% at 7 year. For CML-CP1, OS is 83.2% and CML-AP/BC is 33.3% (P<0.05). Compared patients of advanced CML achieving CP2 after IM and with no CP2,the former has better results of CCR or MCR, OS and PFS (P<0.05). The total treatment related mortality (TRM) is 16.8%. Cox multivariate regression analysis of prognostic factors indicates that status of CML and severe acute graft-versus-host disease (aGVHD III-‡W) retain independent predictive value. No increase in rates of serious adverse events was observed with continuous use of IM for up to 7 years. Conclusions: For chronic myeloid leukemia, combining with imatinib mesylate and allogeneic transplantation is a good strategy, with favorable long-term follow-up results and acceptable TRM, especially for the patients with advanced CML. Disclosures: No relevant conflicts of interest to declare.

Chronic Myeloid Leukemia. 15-Years Experience at a Single Institution in Mexico City.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4557-4557
Author(s):  
Alvaro Aguayo ◽  
Eunice Garcia-Alvarez ◽  
Yael Cazares-Ordonez ◽  
Erick Crespo-Solis ◽  
Deborah Martinez-Banos ◽  
...  
Keyword(s):  
Chronic Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Chronic Phase ◽  
Cytogenetic Response ◽  
Treated Group ◽  
Front Line ◽  
Hematopoietic Stem ◽  
Historical Group ◽  
Previously Treated

Abstract Chronic myeloid leukemia (CML) is a malignant disease of the hematopoietic stem cell caused by the t(9;22)(q13;q11). The disfunctional hybrid-protein (PBCR-ABL) produced has a tyrosin kinase activity leading to a factor-independent myeloid proliferation and leukemic transformation. Imatinib mesilate (IM), a competitive inhibitor of PBCR-ABL, is now considered the treatment of choice for patients (pts) with CML. The primary goal of the treatment is to reach a complete cytogenetic response (CCgR) which is achieved in 48% of previously-treated chronic phase (CP)-CML pts and 87% with front-line IM. We retrospectively analyzed and compared the demographics, clinical data and outcome of all CML patients with at least 3-months of follow-up referred to our Institution (INCMNSZ) from January 1992 to April 2007. RESULTS: Ninety-nine medical charts were evaluated and divided in IM-treated group and a historical group. Median age was 37-y (12–79), 52.5% pts were male, 29.2% were asymptomatic, 64.4% had anemia, 37.4% had bleeding, and 46.5% pts had fever at diagnosis. Hepatomegaly, splenomegaly and lymphadenopathy were present in 20/92 (21.7%), 54/93 (58.1%), and 22/96 (22.9%) respectively. At diagnosis 85 (86%) pts were in CP; 7 (7%) in accelerated phase (AP), and 7 (7%) in blastic phase (BP). Hasford risk was low in 49 (49.5%), intermediate in 34 (34.3%) and high in16 (16.2%) of the pts. Table 1 summarizes demographics and clinical variables by groups. Table 1. Characteristics by group Variable Imatinib (n=57) Historical (n=42) Male 26 (45.6%) 26 (61.9%) Median age 33 (12–79) 41 (15–75) Asymtomatic 7 (12.3%) 13 (31%) Anemia 34 (59.6%) 30 (71.4%) Bleeding 19 (33.3%) 18 (42.9%) Fever 26 (45.6%) 20 (47.6%) Hepatomegaly 14/50 (28%) 6/42 (14.3%) Splenomegaly 35/51 (68.6%) 19/42 (45.2%) lymphadenopathy 16/54 (29.6%) 6/42 (14.3%) CML-CP 51 (89.5%) 34 (81%) CML-AP 2 (3.5%) 5 (7.1%) CML-BP 4 (7%) 3 (7.1%) Hasford Low-Risk 31 (54.4%) 18 (42.9%) Hasford Intermediate-Risk 17 (29.8%) 17 (40.5%) Hasford High-Risk 9 (15.8%) 7 (16.7%) Fifty-seven patients were treated with IM, of them 31/57 (54.4%) received IM as front-line therapy and 26/57 (45.6%) were previously treated. Interferon alfa (IFNa) was given to 17/26 (65.3%) of the pts in IM group. Responses by group of therapy are listed in Table 2. Table 2. Response by groups Variable Imatinib (n=57) Historical (n=42) * 5 pts too early for Cg evaluation; ** BMT pts CHR 52 (91.2%) 17 (40.5%) CgR 42/52* (80.8%) 2** (4.8%) CCgR 37/42 (88.1%) 2 (4.8%) Alive in CCgR @ last F-U 25/57 (43.9%) 1 (2.4%) Progress to BP @ last F-U 7/57 (12.3%) 14 (33.3%) Patients exposed to IFNa prior to receive IM had a CCgR of 58.8% compared to patients in whom IFNa was not given before IM, 77.8%. At a median follow-up of 26.2 mo, 54/57 (94.7%) pts in the group of IM were still alive; 25/57 (43.9%) pts are in CCgR, 3/57 (5.3%) with partial CgR. Eight of fifty-seven (14%) pts progressed to AC or BP and 3 pts died in BP-CML. In the historical group there is 1/42 (2.4%) alive in CCgR and 40/42 (95.2%) have progressed to AC or BP-CML. This is the first Mexican series reported comparing CML pts treated with IM and historical controls. The number of pts is representative of our Institution and the data are in accordance with the literature.

Interferon Alpha Alone Is Able to Cure Chronic Myeloid Leukemia In a Small Subset of Patients Despite the Persistence of Leukemic Cells: Experience of Long Follow up After Treatment Discontinuation

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2299-2299 ◽  
Author(s):  
Francois-Xavier Mahon ◽  
Marie-Pierre Fort ◽  
Gabriel Etienne ◽  
Gerald Marit ◽  
Noel Milpied ◽  
...  
Keyword(s):  
Chronic Myeloid Leukemia ◽  
Quantitative Pcr ◽  
Median Time ◽  
Interferon Alpha ◽  
Myeloid Leukemia ◽  
Residual Disease ◽  
Leukemic Cells ◽  
Hematopoietic Stem ◽  
Ifn Treatment

Abstract Abstract 2299 Before the imatinib era and besides allogeneic hematopoietic stem cell transplantation (HSCT), interferon alpha (IFN) was an alternative therapeutic option to treat chronic myeloid leukemia (CML). In very rare situations, some patients achieved a complete molecular remission (CMR) defined as the absence of detectable BCR-ABL transcript using qualitative PCR available at that time.We previously reported the outcome of patients with CML in complete cytogenetic remission after cessation of IFN (J Clin Oncol., 2002, 20:214-220.). Here, we update this experience with a long outcome after discontinuation of IFN. The main criteria for IFN discontinuation was the achievement of a sustained CMR lasting for at least two years. Twenty-one patients (9 males, 12 females; median age 39 years) were eligible for this study. One, 2 and 18 pts belonged to respectively high, intermediate and low risk group according to the Sokal score.All patients were treated with IFN (median dose 56ui/week) during a median time of 7.5 years (2.4-14) and 4 of them received an autologous HSCT. The median time to achieve CMR was 54 month (5-140). The median follow up after discontinuation of IFN treatment was 8 years (mean 9, range 5–18). Quantitative PCR was used to quantify BCR-ABL and evaluate residual disease. We distinguished two groups of patient according to the molecular pattern: group 1 (n=12) regards patients with sustained CMR confirmed by quantitative PCR. One patient belonging to this group relapsed and progressed suddenly after 5 years of IFN discontinuation and was treated with allogeneic HSCT. Group 2 (n=9) regards patients who are not in CMR with leukemic cells detectable by RQ-PCR. Six of them exhibit a fluctuation of BCR-ABL detection assessed by RQ-PCR. For the 3 other patients with a median follow up of 6 years after discontinuation, RQ-PCR became clearly positive after a median time of 2 years with a level of residual disease that corresponds to the definition of major molecular response (3 log reduction of BCR-ABL). No progression was observed in this group. So we conclude that the persistence of leukemic cells at low level after discontinuation of IFN treatment does not automatically lead to CML relapse. This long term follow up after IFN discontinuation raises the question of the need of a complete eradication of residual leukemic cells to cure the disease Disclosures: No relevant conflicts of interest to declare.

scholarly journals The Association between Chronic Myeloid Leukemia and Heart Failure

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4603-4603
Author(s):  
Pyi Phyo Aung ◽  
Kyeeun Park ◽  
Khaled Himed ◽  
Jeffy Jacob
Keyword(s):  
Heart Failure ◽  
Cardiovascular Diseases ◽  
Chronic Myeloid Leukemia ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Myeloid Leukemia ◽  
The United States ◽  
Categorical Variables ◽  
Hematopoietic Stem ◽  
Peripheral Arterial Diseases

Abstract Introduction The first and second leading causes of death in the United States are heart disease and cancer respectively. Chronic myeloid leukemia (CML) is a hematopoietic stem cell malignancy diagnosed at the mean age of 66. The rate of cardiovascular diseases in CML have been increased with the advent of therapies such as tyrosine kinase inhibitors (TKIs) as well as the improved survival rate with the treatments. Heart failure is one the most commonly identified cancer-therapy related cardiovascular adverse events. In this study, we are using national population cohort to study the association between CML and heart failure. Methods We conducted a retrospective analysis of 3 years of National inpatient sample (HCUP-NIS) from 2016 to 2018 data base. Patient older than 60 years old and with or without CML was selected using ICD-10 diagnosis code. Principal diagnosis of congestive heart failure and cardiogenic shock were included with the code. Discharge-level weight analysis was used to produce national estimate. Continuous variables were compared by t-test, while chi-square and Fisher's exact test for categorical variables. Finally, multivariate logistic regression was used to calculate odds ratio for inpatient mortality and multivariate linear regression for length of stay using STATA 17 statistical software. Results A total of 45,724,104 admissions met for inclusion criteria and 43,505 patients (0.095 %) have CML. Patients with CML are more likely to be of older age (75.2 v 74.9, p &lt;0.002), male (55.2% v 46.8%, p &lt; 0.0001) and white (79.7% v 76.0%, p &lt; 0.0001). They are also associated with lower prevalence of diabetes (16.5% v 20.1%, p &lt; 0.0001) and smoking (0.6% v 0.8%, p &lt;0.0001) but higher prevalence of peripheral arterial diseases (13.7% v 11.6%, p &lt;0.0001). During the study period, a total of 9,339,737 patients were admitted primarily due to CHF and 12,835 of patients (0.14%) have underlying CML. There was no statistical difference in deteriorating to cariogenic shock in CHF patients with and without CML (2.06% v 2.10%, p &lt;0.805). After adjusting for age, sex, race, diabetes, Charlson comorbidity index, there was statistical significance in mortality (OR 1.18, CI 1.09 - 1.27, p &lt; 0.0001) and longer length of stay by 0.28 day (p &lt; 0.0001) Discussions This study describes patient's demographic, in-patient mortality rate and length of stay in patients with CML and heart failure. A comorbid heart failure is associated with higher mortality rate and longer length of stay in hospital. Even though multiple societies have published several guidelines for baseline assessment of the cardiovascular risk factors, there is no standardized assessment tool for risk stratification and management of heart failure in CML patients. Moreover, presence of heart failure can be a limitation on treatments of CML and carry a poor prognosis. Our study emphasizes the importance of assessing cardiovascular diseases and optimizing the care before, during and after the treatment of CML. Disclosures No relevant conflicts of interest to declare.

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