Therapy and quality of life in chronic myeloid leukemia

This study reviewed recent research on the long-term health related quality of life for patients with chronic myeloid leukemia (CML). The authors concluded that while CML patients may now expect to lead long lives, more attention needs to focus on managing treatment side effects.

The prognosis for patients with CML has dramatically improved due to tyrosine kinase inhibitor (TKI) therapy. TKIs block a protein involved in cancer cell growth and spread. While TKIs lead to long-term survival, they are also long-term treatments. Many patients can expect to use TKI therapy for most of their lives. Therefore, understanding the short- and long-term side effects is especially important for maintaining quality of life.

A great deal of attention is focused on grade 3 or 4 side effects, as these are severe and even life-threatening. In the long-term, however, it is the less severe (grades 1 and 2) effects that need attention. These are the effects that patients may need to live with for long periods that may affect quality of life.

The current study reviews the long-term health-related quality of life in CML patients.

TKI therapies can lead to different side effects. One study included 406 patients treated with 400 mg of imatinib (Gleevac). Of these, 38% experienced swelling, 35% experienced gastrointestinal issues (such as diarrhea), 22% experienced muscle pain, and 14% experienced fatigue. Most effects occurred in the first few years of treatment. Similar side effects occurred with other TKI therapies. Patients treated with dasatinib (Sprycel) had an increased rate of fluid build-up in the chest. This effect was seen after 5 years of treatment. Patients treated with nilotinib (Tasigna) had increased rates of cardiovascular complications. After 5 years, 12.6% of patients experienced heart disease, cerebrovascular disease (such as stroke), or peripheral artery disease (reduced blood flow to the arms and legs).

Treatments work best when patients take them as prescribed. In one study, 4-year survival was 91% in patients who followed their treatment regimen and 72% in those who did not. Another study noted younger patients (under 50), those not taking other medications, and those treated with imatinib were less likely to follow medication directions.

This review concluded that more attention is needed on quality of life and managing treatment side effects in the long-term for patients with CML.

Research focusing on new treatments with fewer side effects that can lead to a cure is ongoing.