Comorbidity predicts outcome in TKI-treated CML patients
medwireNews: Greater comorbidity burden at diagnosis is significantly associated with poor outcome in chronic myeloid leukaemia (CML) patients treated with tyrosine kinase inhibitors (TKIs), a study shows.
The research also found that the Charlson comorbidity index (CCI) outperformed both the Sokal and Hasford CML-specific disease progression scoring systems with regard to predicting patient outcome.
The retrospective study included 79 patients (33 women) who were diagnosed with chronic phase–CML from 2001–2012 in the Kagawa prefecture of Japan. Most were treated with imatinib, although some received nilotinib or dasatinib for relapsed or refractory disease.
The researchers categorised patients by risk using the Sokal and Hasford scores, as well as the CCI, using their data at time of diagnosis. They found that, over a median follow-up of 55.5 months, only one of the five patients who died was classified as high risk according to Sokal scoring, and none were classified as high risk by Hasford score.
By contrast, four of the five deaths occurred in patients classified as high risk by CCI (CCI≥3). And compared with the 52 patients who scored lowest on the CCI (≤2), the 27 patients with a CCI score of at least 3 had significantly shorter survival.
The research team, who reported their results in the International Journal of Hematology, also found that all five deaths that occurred during the study were not attributable to CML itself, but to other comorbid conditions.
“Therefore, it can be said that one of the greatest concerns with CML care is control of other underlying diseases and not primarily CML, assuming successful TKI treatment”, write authors Osamu Imataki (Kagawa University, Miki-town, Japan) and colleagues.
“In fact, management of comorbidities may improve CML patient survival,” they add.
They note that although all three scoring systems could independently predict survival, neither the Sokal or Hasford scores correlated with the CCI. Therefore, they say, “the prognosis of the disease and the prognosis due to comorbidities are independently involved in survival.”
The authors suggest that a CML diagnosis can actually have a paradoxical effect on people’s health by drawing their attention to it and any coexisting conditions. “Under such circumstances, a person with CML could potentially survive longer than patients without CML”, they write.
Imataki et al say that, particularly given the efficacy of targeted therapies for CML, the need to properly control underlying diseases that contribute towards prognosis is even greater.
“Proper and effective management of common diseases is an important part of keeping cancer patients healthy. When cancer becomes chronic, simultaneous management of other concomitant diseases together with the cancer is of utmost importance”, they conclude.
By Kirsty Oswald
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