Symptom burden for patients with chronic myeloid leukemia treated with tyrosine kinase inhibitors

This study aimed to investigate the symptom burden on patients with chronic phase chronic myeloid leukemia (CP-CML) who were treated with second or third generation tyrosine kinase inhibitors.

This study concluded that the side effects of this treatment may affect the quality of life for these patients.

Chronic myeloid leukemia (CML) is commonly treated with tyrosine kinase inhibitors (TKIs). TKIs work to block a protein on cancer cells. This protein sends growth signals to cells. By blocking this protein, the growth of cancer cells can be stopped. Second and third generation TKIs such as dasatinib (Sprycel), nilotinib (Tasigna) and ponatinib (Iclusig), are developed from earlier TKIs and have better activity. Treatment with TKIs may need to continue for years or possibly indefinitely.

TKIs are generally safe but may have unknown effects on the patient’s quality of life. Symptom burden can be defined as the frequency and severity of symptoms that place a physical burden on the patient. The burden can produce negative, physical and emotional responses. The symptom burden for patients with CML treated with second and third generation TKIs is unknown.

This study involved 219 patients with CP-CML that were being treated with TKIs. The TKIs used were dasatinib, nilotinib, and ponatinib. The symptom burden of these patients was measured. Patients completed a questionnaire before the start of treatment and at 3,6,9,12,18 and 24 months. The average follow-up period was 54 months. 

The most common symptom in all patients was fatigue. This was experienced before, during and after treatment. Disturbed sleep and drowsiness were also reported. These symptoms were reported more commonly at 6-9 months of treatment and improved gradually over time. The component of daily living that was most affected was work.

Therapy was well tolerated by most patients. A small number of patients needed dose reductions due to side effects. 31% of patients who participated achieved complete molecular remission (no evidence of cancer in the blood) by 24 months of treatment. 90% of patients who participated experienced persistent mild symptoms.  

This study concluded that the side effects of TKIs may affect the quality of life for patients with CP-CML.

Further studies are needed to investigate factors associated with the symptoms and ways of improving the quality of life while being treated.

Consult your physician if you have any concerns about TKI treatments and their side effects.