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Imatinib and polypharmacy in very old patients with chronic myeloid leukemia: effects on response rate, toxicity and outcome.


ABSTRACT:

Background

About 40% of all patients with chronic myeloid leukemia are currently old or very old. They are effectively treated with imatinib, even though underrepresented in clinical studies. Furthermore, as it happens in the general population, they often receive multiple drugs for associated chronic illnesses. Aim of this study was to assess whether or not in imatinib-treated patients aged >75 years the exposure to polypharmacy (5 drugs or more) had an impact on cytogenetic and molecular response rates, event-free and overall survival, as well as on hematological or extra-hematological toxicity.

Methods

296 patients at 35 Italian hematological institutions were evaluated.

Results

Polypharmacy was reported in 107 patients (36.1%), and drugs more frequently used were antiplatelets, diuretics, proton pump inhibitors, ACE-inhibitors, beta-blockers, calcium channel blockers, angiotensin II receptors blockers, statins, oral hypoglycemic drugs and alpha blockers. Complete cytogenetic response was obtained in 174 patients (58.8%), 78 (26.4%) within 6 month, 63 (21.3%) between 7 and 12 months. Major molecular response was obtained in 153 patients (51.7%), 64 (21.6%) within the 12 month. One hundred and twenty-eight cases (43.2%) of hematological toxicity were recorded, together with 167 cases (56.4%) of extra-hematological toxicity. Comparing patients exposed to polypharmacy to those without, no difference was observed pertaining to the dosage of imatinib, cytogenetic and molecular responses and hematological and extra-hematological toxicity.

Conclusion

Notwithstanding the several interactions reported in the literature between imatinib and some of the medications considered herewith, this fact does not seem to have a clinical impact on response rate and outcome.

SUBMITTER: Iurlo A 

PROVIDER: S-EPMC5346773 | biostudies-literature | 2016 Nov

REPOSITORIES: biostudies-literature

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Publications

Imatinib and polypharmacy in very old patients with chronic myeloid leukemia: effects on response rate, toxicity and outcome.

Iurlo Alessandra A   Nobili Alessandro A   Latagliata Roberto R   Bucelli Cristina C   Castagnetti Fausto F   Breccia Massimo M   Abruzzese Elisabetta E   Cattaneo Daniele D   Fava Carmen C   Ferrero Dario D   Gozzini Antonella A   Bonifacio Massimiliano M   Tiribelli Mario M   Pregno Patrizia P   Stagno Fabio F   Vigneri Paolo P   Annunziata Mario M   Cavazzini Francesco F   Binotto Gianni G   Mansueto Giovanna G   Russo Sabina S   Falzetti Franca F   Montefusco Enrico E   Gugliotta Gabriele G   Storti Sergio S   D'Addosio Ada M AM   Scaffidi Luigi L   Cortesi Laura L   Cedrone Michele M   Rossi Antonella Russo AR   Avanzini Paolo P   Mauro Endri E   Spadea Antonio A   Celesti Francesca F   Giglio Gianfranco G   Isidori Alessandro A   Crugnola Monica M   Calistri Elisabetta E   Sorà Federica F   Rege-Cambrin Giovanna G   Sica Simona S   Luciano Luigiana L   Galimberti Sara S   Orlandi Ester M EM   Bocchia Monica M   Tettamanti Mauro M   Alimena Giuliana G   Saglio Giuseppe G   Rosti Gianantonio G   Mannucci Pier Mannuccio PM   Cortelezzi Agostino A  

Oncotarget 20161101 48


<h4>Background</h4>About 40% of all patients with chronic myeloid leukemia are currently old or very old. They are effectively treated with imatinib, even though underrepresented in clinical studies. Furthermore, as it happens in the general population, they often receive multiple drugs for associated chronic illnesses. Aim of this study was to assess whether or not in imatinib-treated patients aged >75 years the exposure to polypharmacy (5 drugs or more) had an impact on cytogenetic and molecul  ...[more]

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