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Impact of comorbidities on overall survival in patients with chronic myeloid leukemia: results of the randomized CML-Study IV

Item Type:Article
Title:Impact of comorbidities on overall survival in patients with chronic myeloid leukemia: results of the randomized CML-Study IV
Creators Name:Saussele, S. and Krauss, M.P. and Hehlmann, R. and Lauseker, M. and Proetel, U. and Kalmanti, L. and Hanfstein, B. and Fabarius, A. and Kraemer, D. and Berdel, W.E. and Bentz, M. and Staib, P. and de Wit, M. and Wernli, M. and Zettl, F. and Hebart, H.F. and Hahn, M. and Heymanns, J. and Schmidt-Wolf, I. and Schmitz, N. and Eckart, M.J. and Gassmann, W. and Bartholomaeus, A. and Pezzutto, A. and Oppliger Leibundgut, E. and Heim, D. and Krause, S.W. and Burchert, A. and Hofmann, W.K. and Hasford, J. and Hochhaus, A. and Pfirrmann, M. and Mueller, M.C.
Abstract:We studied the influence of comorbidities on remission rate and overall survival (OS) in patients with chronic myeloid leukemia (CML). Participants of the CML-Study IV, a randomized five-arm trial designed to optimize imatinib therapy were analyzed for comorbidities at diagnosis using the Charlson Comorbidity Index (CCI). 511 indexed comorbidities were reported in 1519 CML patients. Age was an additional risk factor in 863 patients. Resulting CCI scores were: CCI 2: n=589, CCI 3 or 4: n=599, CCI 5 or 6: n=229, and CCI >/= 7: n=102. No differences in cumulative incidences of accelerated phase, blast crisis, or remission rates were observed between patients in the different CCI groups. Higher CCI was significantly associated with lower OS probabilities. The 8-year OS probabilities were 93.6%, 89.4%, 77.6%, and 46.4%, for patients with CCI 2, 3-4, 5-6 and >/= 7. In multivariate analysis, CCI was the most powerful predictor of OS, which was still valid after removal of its age-related components. Comorbidities have no impact on treatment success but do have a negative effect on OS indicating that survival of patients with CML is determined more by comorbidities than by CML itself. OS may therefore be inappropriate as outcome measure for specific CML treatments. The trial was registered at www.clinicaltrials.gov as #NCT00055874.
Keywords:Antineoplastic Combined Chemotherapy Protocols, Benzamides, Combined Modality Therapy, Comorbidity, Cytarabine, Hematopoietic Stem Cell Transplantation, Interferon-alpha, BCR-ABL Positive, Chronic, Myelogenous Leukemia, Piperazines, Pyrimidines, Survival Analysis, Treatment Outcome
Source:Blood
ISSN:0006-4971
Publisher:American Society of Hematology (U.S.A.)
Volume:126
Number:1
Page Range:42-49
Date:2 July 2015
Official Publication:https://doi.org/10.1182/blood-2015-01-617993
PubMed:View item in PubMed

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