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ASH 2014: Survival in the TKI age

written by

Leukaemia Care, Charity

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People with chronic myeloid leukaemia (CML) who respond to a TKI (tyrosine kinase inhibitor) can expect to live a little bit longer than similarly aged people without CML in the general population, according to a new analysis by researchers at the MD Anderson Cancer Center, Houston, Texas. The findings were presented at the 56th American Society of Haematology (ASH) annual meeting.

The study looked at survival in a group of 483 people who had enrolled in trials of Gleevec, Sprycel or Tasigna (all first-line TKIs). Ages ranged from 15 to 85 years, with most people in the 45-65 age group. A majority of people in all age groups had low-risk chronic-phase CML.

The usual benchmark of treatment success is a complete cytogenetic response (CCyR) in the first year of treatment. Overall, 87% of people aged 15-45 years, 94% of those aged 46-65 and 92% of those aged 66-85 achieved CCyR. So most can have a successful course of treatment, including those older than age 65.

At five years, the survival rates for the three age groups was 96%, 94% and 80%, respectively. A lower proportion of older individuals survived five years (80%), but this may be attributed to the lower survival rate in general for people after age 65. So the researchers also compared these survival rates with those for the general public.

For the full group (ages 15-85), five-year survival was only slightly lower for people with CML (92.7%) compared to people in the general population (94.4%). The five-year survival rates by age group were 96.2% for those aged 15-45 years (vs. 99.3% in the general population), 93.5% for those aged 46-65 years (vs. 96.3%), and 80.1% for those aged 66-85 years (vs. 82.5%).

As you might expect, long-term survival was even better if a person had a good response to treatment. For those who achieved CCyR within a year of starting treatment, the five-year survival (all ages) was 97.3%. For people without CML it was 94.4%. So people with CML were slightly more likely to survive.

This difference was even better for those who achieved a major molecular response (MMR) in the first year of treatment. Five-year survival was 97.9% – compared to 94.4% of the general population. People achieving a 4.5-log reduction or a complete molecular response (CMR; also called molecularly undetectable leukemia) were also somewhat more likely to survive five years (rates of 97.1% and 96.7%, respectively).