medwireNews: Patients with chronic myeloid leukaemia (CML) can now expect to live almost as long as members of the general population, say researchers.
They point out certain caveats, however – noting that reported elevations in the incidence of second malignancies and tyrosine kinase inhibitor (TKI)-related cardiovascular morbidity could negatively affect survival gains. Moreover, the life expectancy of individuals diagnosed in an advanced phase of CML is unlikely to approach that of the general population, the team explains.
“Even so, the life expectancy of patients with CML was within 3 years of the life expectancy of the general population for diagnoses in 2010, which can be seen as a great success of CML treatment”, the study authors comment in the Journal of Clinical Oncology.
Using the population-wide Swedish Cancer Registry, they identified 2662 individuals, with a minimum age at diagnosis of 50 years, who received a CML diagnosis between 1973 and 2013.
From 1973 to 1990, the life expectancy of patients of all ages increased steadily, while between 1990 and 2000, younger patients (55 or 65 years at diagnosis), but not older (75 or 85 years at diagnosis), experienced a large rise. After 2000, the increase in life expectancy for younger patients was less marked, but this is when patients aged 85 years at diagnosis experienced the greatest increase.
Although the patterns varied across age groups, overall, CML patients of all ages experienced “dramatic” improvements in life expectancy during the study period, with the life expectancy in 2013 approaching that of the general population, say Hannah Bower (Karolinska Institutet, Stockholm, Sweden) and co-investigators.
These improvements translated into reductions in the loss in expectation of life, a measure of the number of life–years lost due to a cancer diagnosis. Decreases were seen in all age groups, but were greatest in younger patients diagnosed after 1990. And on average, individuals of any age diagnosed after 2010 can expect to lose less than 3 life–years as a result of CML.
Interestingly, the time period of greatest improvement in younger patients was before the TKI imatinib was introduced in 2001 in Sweden, and although older patients experienced improvements from 2000 onwards, “no immediate improvement was seen after 2001”, observe Bower et al.
Therefore, they believe that “[t]he use of interferon alfa, more precise diagnostics that involve centralized [cytogenetic] laboratories, and a more structured approach in treating and monitoring patients with CML are plausible explanations for the trend.”
Bower et al continue: “Although the present research suggests that improvements in survival of patients with CML over the years may not have been completely a result of the introduction of [imatinib mesylate], it is clear that the prognosis for patients with CML today is extremely positive with the current treatment.”
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