In an observational prospective study by the CML Italian network, researchers analyzed the role of baseline patient characteristics and first-line treatments on overall survival and chronic myeloid leukemia (CML)–related mortality. The findings were published in Frontiers in Oncology.
The study included 1,206 patients with newly diagnosed CML. A total of 608 were treated with imatinib and 598 with a second-generation tyrosine kinase inhibitor (TKI). According to the report, imatinib-treated patients were much older (median age = 69 years) than the second-generation TKI group (median age = 52 years). The imatinib-treated group also had more comorbidities.
Among the entire cohort, the estimated four-year overall survival was 89%. A total of 73 patients (6.1%) died during follow-up, which included 17 (2.8%) in the second-generation TKI group and 56 (9.2%) in the imatinib cohort. This translated to an adjusted hazard ratio (HR) of 0.50 in favor of second-generation TKI, but no differences were detected for CML-related mortality (10 patients [1.7%] vs. 11 patients [1.8%]; HR = 1.61).
Analysis of survival with patient factors found that the EUTOS long-term survival (ELTS) score was associated with CML mortality (high risk vs. low, HR = 9.67; P < 0.001). The following factors were associated with an increased risk of CML-unrelated mortality:
- age (HR = 1.03; P = 0.064)
- Charlson Comorbidity Index (4-5 vs. 2, HR = 5.22; P < 0.001)
- ELTS score (high risk vs. low, HR = 3.11; P = 0.002)
- second-generation TKI vs. IMA (HR = 0.26; P= 0.004)
The authors noted that the ELTS score showed a better discriminant ability than the Sokal score in all comparisons.