Evaluation of outcomes of results in patients with cml treated with second generati̇on tkis: ege hematology experience

Although chronic myeloid leukemia (CML) has been known for long time, the fate of the disease and the survival plots of patients have been dramatically changed after discovery of İmatinib, the first TKI, and other TKIs. We hereby retrospectively evaluated demographic, clinical and treatment characteristics as response in patients with CML treated with 2nd generation TKIs in our center. Sixty nine Imatinib-resistant or intolerant patients who were treated with dasatinib or nilotinib were included in our study. Patient's clinical and demographic parameters, rates of 3rd, 6th, and 12th months MMR achievement, loss of MMR over 12-24 month and after 24 month, rate of CCyR and CHR after taking 2nd generation TKİs were considered for evaluation. All patients were in chronic phase Thirty four patients were men, 35 were women. The mean age was 53,7. Rate of low sokal risk score was 36,2% (17 patients), intermediate risk was 40,4% (19 patients) and high risk group was 23,4% (11 patients). As for the HASFORD risk score; groups were 53,2 low% (25 patients), 31,9 % intermediate (15 patients), 14,9 %high (7 patients). Out of sixty nine patients, thirty seven used nilotinib, fifty nine patient used dasatinib. There were 27 patient who used both of 2nd generation TKIs. For patients treated with Nilotinib; the third, 6th and 12th months MMR achievement rates were 76%, 73,7% and 85,7% respectively. While these were 70,6% and 71,4% over 12-24 months and after 24 months respectively. CHR and CCyR rates were 91,9% . For patients treated with Dasatinib; the third, 6th and 12th months MMR achievement rates were 62,2%; 71,4% and 71,4% respectively, while it was 66% and 62,3% over 12-24 month and after 24 months respectively. CCR and CHR rates were 93,1%. The rate of side effects in patients treated with Nilotinib was 29,7% and 30,5% for Dasatinib with no differences. We have evaluated the overall survival (OS) for all patients and it was found 93 months for all patients and; 66 and 72 months for dasatinib and nilotinib respectively. Event free survival (EFS) rate for 2nd generation TKIs were 73 months, for dasatinib 55 months, for nilotinib 32 months. Transformation to accelerated phase was observed only in 3 patients. Those patients are non-responsive to both Nilotinib and Dasatinib. Out of ten deaths 50,% was found to be related to CML. There were no statistically differences in OS and EFS in terms of treatment with Dasatinib or Nilotinib. In our CML population, there were no apparent differences in treatment with either Nilotinib or Dasatinib of patients with CML in terms of efficacy, side effect profile, long term safety and OS, and EFS. Treatment selection for patients with CML resistant or intolerant to imatinib should be personalized based on patients characteristics