Comparison of Clinicopathological Parameters, and Treatment Responses in Younger and Older Chronic Myeloid Leukaemia Patients Treated with Imatinib

Ahmad Farhan Kamarudin, Sivakumar Palaniappan, Raja Zahratul Azma Raja Sabudin, S. Shuib, Siti Afiqah Muhamad Jamil, N. Tumian
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Abstract

Introduction: Differences in baseline characteristics and response to treatment in different age groups of patients with chronic myeloid leukaemia (CML) in resource-limited countries have not been extensively studied. We aimed to determine the differences in clinicopathological parameters at diagnosis and response to imatinib in adult CML patients with younger (under 60 years; YCML) and older (60 years and older; OCML) age treated at our institution from March 2001 to March 2021. Methods: A retrospective analysis of consecutive adult CML patients receiving imatinib was performed. Clinicopathological parameters and treatment response were reviewed and analysed using hospital medical records and electronic data reports. Results: The median age at diagnosis was 50 years. OCML patients (n=17) had significantly more comorbidities. The YCML group (n=50) generally had a palpable spleen >5cm from the costal margin, mild anaemia, hyperleukocytosis and thrombocytosis. A starting dose of 400 mg/day was observed in 84% of YCML and in 65% of OCML. Cumulative complete cytogenetic response was 50% in YCML versus 70.6% in OCML, p=0.158. OCML tended to have a higher percentage of major molecular response (MMR) (52.9% versus 32%) and a shorter time to MMR, 22 months (range 5-70) versus 35 months (range 8-53). OCML experienced more haematological and non-haematological treatment-related adverse events after imatinib therapy. Conclusion: Although OCML patients had more comorbidities and treatment intolerances, overall long-term treatment response was comparable to YCML. In OCML, a more personalised approach to initial and subsequent dosing of imatinib may be considered.
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使用伊马替尼治疗的年轻和老年慢性粒细胞白血病患者的临床病理参数和治疗反应比较
导言:在资源有限的国家,不同年龄组慢性髓性白血病(CML)患者的基线特征和治疗反应差异尚未得到广泛研究。我们旨在确定 2001 年 3 月至 2021 年 3 月期间在本院接受治疗的年龄较小(60 岁以下;YCML)和年龄较大(60 岁及以上;OCML)的成年 CML 患者在诊断时的临床病理参数和对伊马替尼的反应的差异。方法对连续接受伊马替尼治疗的成年 CML 患者进行回顾性分析。利用医院病历和电子数据报告对临床病理参数和治疗反应进行回顾和分析。结果显示诊断时的中位年龄为 50 岁。OCML患者(17人)的合并症明显较多。YCML 组(50 人)一般可触及距肋缘大于 5 厘米的脾脏、轻度贫血、白细胞和血小板增多。84% 的 YCML 和 65% 的 OCML 的起始剂量分别为 400 毫克/天。YCML的累积完全细胞遗传学反应为50%,而OCML为70.6%,P=0.158。OCML 的主要分子反应(MMR)比例更高(52.9% 对 32%),MMR 的时间更短,为 22 个月(5-70 个月)对 35 个月(8-53 个月)。伊马替尼治疗后,OCML患者出现更多血液学和非血液学治疗相关不良事件。结论虽然 OCML 患者有更多的合并症和治疗不耐受,但总体长期治疗反应与 YCML 相当。对于 OCML 患者,可以考虑对伊马替尼的初始剂量和后续剂量采用更加个性化的方法。
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