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Chronic myeloid leukaemia (CML) requires lifelong treatment and management. Although tyrosine kinase inhibitor (TKI) treatments have improved patient outcomes greatly, with CML patients in chronic phase treated with TKIs now having an average life expectancy close to that of the general population1 – challenges do still persist.
To help you maintain optimal management and care of patients with CML:
Keep abreast of the ELN and BSH guidelines for the latest guidance on treatment response milestones and monitoring
Understand AEs from TKIs may be having a big impact on patient’s wellbeing
Encourage your patients to speak openly and honestly about how they feel about their condition and treatment
CML is perceived to be easier to treat, and to have better outcomes than other types of cancers, but adverse events (AEs) like fatigue or diarrhoea can cause serious disruption to a patient’s life, especially when they persist for long periods of time.2,3 Long-term TKI treatment can also lead to cardiovascular and musculoskeletal toxicities.3 Resistance or intolerance to TKI agents can be common.9 Another element to bear in mind is that patients may not always be willing to reveal the suffering they endure in their daily lives due to symptoms and side-effects. That’s why it’s vital to follow recommended guidelines, question patients proactively, develop personalised treatment plans, and measure both response and intolerance to treatment.
Taking a closer look at CML
- CML is a progressive disease requiring long-term treatment. Without therapeutic intervention, patients in the CML-chronic phase (CML-CP) progress to accelerated phase (AP), and ultimately to blast crisis (BC).4,5
- Although the life expectancy of a newly diagnosed patient with CML-CP is now very close to that of the general population2, optimal management of patients with CML-CP who fail to achieve recommended treatment milestones (at 3, 6, and 12 months) is vital to ensure that CML-CP does not progress to a more aggressive disease.
CML disease progression, without treatment
- TKIs are the recommended treatment for CML as per national and international guidelines.6,7 All currently approved TKIs target the adenosine triphosphate (ATP) binding site of ABL1.2
Side-effects often impair patients’ quality of life2,3,8
Most CML patients will require long-term, often lifelong, treatment with TKIs, which can have a big impact on their quality of life.2,3,8
Long-term TKI treatment can result in cardiovascular and musculoskeletal toxicities3
Even though more severe toxicities will have the biggest impact on patients’ quality of life, mild toxicities can have a detrimental effect due to lifelong daily management3
Many patients fail to respond to treatment
A significant proportion of CML patients are resistant or intolerant to TKIs. Unfortunately, this can lead to treatment failure.
30–50% of patients on first-line TKI will experience treatment failure by 5 years2
65% switched from first-line TKI due to resistance9
34% switched from first-line TKI due to intolerance9
63–72% of patients in 2L treatment will fail to achieve response after 2 years of treatment2
Challenges in later lines of therapy
Increased failure rates10,11
Decreased overall survival (OS)2,10,11
Emergence of new mutations2,12
No precise guidelines for patients who fail a second generation TKI6,7
No established standard of care for CML in the 3L+ setting3,6,7
Patients feeling fear or anxiety when stopping or switching treatment13
Greater risk of patients experiencing a wide range of mental health issues and diminished quality of life13,14
Real-world evidence in the UK
50% of patients switched from first line TKI, mostly due to resistance9
21% of patients received ≥3 lines of TKIs9
21% of patients experienced treatment intolerance15
References
- Bower H, et al. J Clin Oncol. 2016;34:2851–7.
- Cortes J, et al. J Hematol Oncol. 2021;14(1):44
- Flynn KE, et al. Curr Hematol Malig Rep. 2016;11(2):80–85
- Baccarani M, et al. Ann Oncol. 2009;20(suppl 4):iv105–iv107.
- Clarke CJ, et al. Exp Hematol. 2017 Mar; 47:13–23.
- National Comprehensive Cancer Network CML Guidelines. Available at: www.nccn.org/patients/guidelines/cml/index.html#1.
- Hochhaus A, et al. Leukemia. 2020;34:966–84.
- Kropf P, et al. J Leuk 2015;3:170.
- Milojkovic D, et al. Br J Haematol, 2021;192:62–74.
- Akard LP, et al. Clin Adv Hematol Oncol. 2013;11:421–432.
- Jabbour E, et al. Clin Lymphoma Myeloma Leuk. 2015;15:323–334.
- Soverini S. Blood. 2009;114:2168–2171.
- Sharf, G, et al. Leukemia. 2020;34:2102–2112.
- Sharf G, et al. Blood. 2019;134 (Supplement_1):2934.
- McMullan RR, et al. Ulster Med J. 2019;88(2):105–110.