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CML outcomes favorable regardless of previous malignancy history
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Survivors of prior malignancies who develop chronic myeloid leukemia may have the same outcomes with tyrosine kinase inhibitors as patients with CML and no prior malignancies, according to research published in Cancer.
“These results mean that patients with history of cancer should be treated for their CML as equally as any other patient, as they can tolerate the treatment well in most instances and can have the same favorable outcome,” Jorge Eduardo Cortes, MD, deputy chair, department of leukemia at the University of Texas MD Anderson Cancer Center told HemOnc Today.
Imatinib, the first TKI to be successfully used in patients with CML, became standard frontline therapy for the malignancy in 2001. Eighty percent of patients treated with imatinib as initial therapy achieve a complete cytogenic response, and approximately 70% achieve a major molecular response by 5 years of therapy.
However, limited data exist that evaluate patients with CML who have a history of prior malignancies.
“As prognosis for many cancers improve, we see more patients with history of one cancer developing a second one,” Cortes said. “Since patients with CML have a normal life expectancy if they are treated properly, we wanted to see if having a history of another cancer impacted their outcome. In some instances, we unfortunately see that this past history may discourage patients or health care providers to think they may not have a good outlook. We wanted to investigate whether this was the case or not, hoping it was not the case.”
Researchers evaluated 626 patients with CML who were treated on trials of TKIs for initial CML therapy between July 2000 and January 2014. The TKIs included imatinib (n = 73), dasatinib (Sprycel; Bristol-Myers Squibb, Otsuka; n = 150), nilotinib (Tasigna, Novartis; n = 148) and ponatinib (Iclusig, Ariad; n = 51).
Overall, 45 patients (7%) had a prior malignancy other than nonmelanoma skin cancer, and 17 patients (3%) had a history of nonmelanoma skin cancer alone.
Characteristics of CML were similar between the patients with no prior malignancy, those with a prior malignancy, and those with nonmelanoma skin cancer. However, patients with a prior malignancy had an older median age at time of CML diagnosis (61.1 years; range, 30.1-84.7) than those with no prior malignancy (47.4 years; range, 14.8-86.4) and those with nonmelanoma skin cancer (57.9 years; range, 36.1-73.5; P < .001).
The most common prior malignancies were nonmelanoma skin cancer (n = 20), breast cancer (n = 11), melanoma (n = 7), prostate cancer (n = 6) and colorectal cancer (n = 5).
Median follow-up for all patients was 84 months (range, 0-180) from the initiation of a TKI.
Overall, a similar proportion of patients with a prior malignancy other than nonmelanoma skin cancer and without prior malignancy achieved 5-year EFS (85% vs. 84%), 5-year failure-free survival (63% vs. 68%) and 5-year transformation-free survival (89% vs. 93%). Results also were similar in patients with a prior history of nonmelanoma skin cancer (5-year EFS, 86%; 5-year failure-free survival, 70%; 5-year transformation-free survival, 86%).
However, 5-year OS results were significantly different among the groups (no malignancy, 93%; history of malignancy other than nonmelanoma skin cancer, 79%; history of nonmelanoma skin cancer, 100%; P = .014).
In a multivariate analysis, advanced age (HR = 1.05; 95% CI, 1.03-1.07) and an elevated creatinine level (> 1.3 mg/dL; HR = 3.09; 95% CI, 1.45-6.57) were associated with worse survival after a diagnosis of CML.
Continued research is needed to investigate whether there are biologic factors that predispose patients to develop multiple malignancies, Cortes said.
“[We also need] to determine how patients can survive two cancers and how we can help others follow this path of dual survivorship,” he added. “If we can identify biologic reasons for this perhaps we could help other patients.” – by Chuck Gormley
For more information:
Jorge E. Cortes, MD, can be reached at jcortes@mdanderson.org.
Disclosure: Cortes reports grants and consulting fees from Ariad, Bristol-Myers Squibb and Novartis, as well as research support from Pfizer and Teva for work outside this study. The other researchers report no relevant financial disclosures.
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