New research led by Yale Cancer Center scientists shows less than a third of older patients with chronic myeloid leukemia (CML) had optimal laboratory monitoring and only two-thirds were adherent to Tyrosine Kinase Inhibitor (TKI) therapy during the first year after diagnosis. TKI treatment can provide a “functional cure” of the disease for many patients with the disease. The findings were reported today at the 2021 American Society of Hematology (ASH) Annual Meeting & Exposition in Atlanta, Georgia.
“We were surprised by the proportion of patients that did not receive any and/or optimal laboratory monitoring to assure the therapy they were receiving was in fact working or to guide a change in therapy,” said Rory Shallis, MD, Assistant Professor of Medicine (Hematology) at Yale Cancer Center and lead author of the study. “We were also surprised that a third of patients were not appropriately adherent to therapy and have concerns that this may have impacted their outcomes.”
For this study, using the SEER-Medicare database, researchers assembled the largest study of 1,192 patients, aged 66-99 years old at diagnosis between 2007-2017 with CML receiving a TKI and followed the patients for at least one year. They found about 20 percent of the patients did not have any evidence guideline-recommended testing and only 28 percent of the patients had “optimal” monitoring. In reviewing adherence to treatment recommendations, they found only 67 percent of patients were reasonably adherent to TKI therapy.
The Yale researchers found that patients with lower socioeconomic status had less laboratory monitoring, but that more recent patients had better monitoring. The team found that adherence to treatment on TKI decreased with increasing age, but improved with later diagnosis (similar to monitoring) as well as with better overall access to healthcare. Lesser monitoring was itself associated with decreased TKI adherence.
“These results highlight areas for improvement in the standards of care for older patients with CML,” said Nikolai Podoltsev, MD, PhD, Associate Professor of Medicine (Hematology) at Yale Cancer Center and senior author of the study. “You can only derive benefit from treatment if you take it. Making sure that older patients with CML are adherent to TKI therapy may help to improve their outcomes.”
Other Yale authors of the study include Rong Wang, PhD, Amer M. Zeidan, MBBS, Scott Huntington, MD, MPH, Natalia Neparidze, MD, Mangyang Di, MD, PhD, and Xiaomei Ma, PhD.
Funding for the study was provided by the Frederick A. DeLuca Foundation.