Can tyrosine kinase inhibitors influence survival rates in chronic phase chronic myeloid leukemia?

This study aimed to investigate the side effects of tyrosine kinase inhibitors and their impact on outcomes in chronic-phase chronic myeloid leukemia patients. This study concluded that severe side effects from tyrosine kinase inhibitors can cause decreased survival rates in these patients.

Tyrosine kinase inhibitors (TKIs) are a type of targeted therapy that can be used to treat chronic myeloid leukemia (CML). Dasatinib (Sprycel), nilotinib (Tasigna) and imatinib (Gleevec) are all types of TKIs. Imatinib is a standard first line treatment for chronic-phase CML. Whether the side effects of TKIs influence the outcomes for patients with chronic phase CML is still under investigation.

This study involved 450 patients who had chronic phase CML and received one or more TKIs as a first line treatment. The TKIs used were dasatinib, nilotinib and imatinib.

46.4% of all patients had comorbidities (other conditions) and 50.4% of all patients were aged over 60 at diagnosis. Both had inferior OS compared to those without comorbidities and aged under 60 years. 

The 5-year overall survival (OS) rate was 95.1%. The 5-year event free survival (EFS) rate was 89%.

Patients who received initial treatment of dasatinib or nilotinib had higher rates of major molecular response (MMR, low levels of BCR-ABL, an abnormal gene present in CML) at 6 and 12 months when compared to those who received imatinib. 

66% of patients who received TKI as a first line treatment needed changes to their treatment plan. 48.4% needed to change treatment due to side effects and 18% due to failure of treatment. Severe side effects were correlated with lower rates of OS and EFS. Common severe side effects were low levels of different types of blood cell, fluid around the lungs, skin rash, and gastrointestinal problems.

This study concluded that severe side effects from TKI treatment led to decreased survival rates in patients with CP-CML. The study also concluded that long term outcomes were similar in these patients regardless of the choice of first line TKI.

Consult your physician about side effects of TKIs.