Real‐world tyrosine kinase inhibitor treatment pathways, monitoring patterns and responses in patients with chronic myeloid leukaemia in the United Kingdom: the UK TARGET CML study

Milojkovic, Dragana; Cross, Nicholas C.P.; Ali, Sahra; Byrne, Jenny; Campbell, Gavin; Dignan, Fiona L.; Drummond, Mark; Huntly, Brian; Marshall, Scott; McMullin, Mary Frances; Neelakantan, Pratap; Raghavan, Manoj; Sivakumaran, Muttuswamy; Tighe, Jane; Wandroo, Farooq; Willis, Fenella; Glen, Fiona; Fildes, Louise; Collington, Sarah J.; Ryan, Jacqueline; Clark, Richard E.; Mead, Adam J.

Abstract

Management of chronic myeloid leukaemia (CML) has recently undergone dramatic changes, prompting the European LeukemiaNet (ELN) to issue recommendations in 2013; however, it remains unclear whether real-world CML management is consistent with these goals. We report results of UK TARGET CML, a retrospective observational study of 257 patients with chronic- phase CML prescribed a first-line TKI between 2013 and 2017, most of whom received first-line imatinib (n=203). Although 44% of patients required ≥1 change of TKI, these real-world data revealed that molecular assessments were frequently missed, 23% of patients with ELN-defined treatment failure did not switch TKI and kinase domain mutation analysis was performed in only 49% of patients who switched TKI for resistance. Major molecular response (MMR; BCR- ABL1IS ≤0.1%) and deep molecular response (DMR; BCR-ABL1IS ≤0.01%) were observed in 50% and 29%, respectively, of patients treated with first-line imatinib and 63% and 54% receiving a second-generation TKI first line. MMR and DMR were also observed in 77% and 44% of evaluable patients with ≥13 months’ follow-up receiving a second-generation TKI second line. We found little evidence that cardiovascular risk factors were considered during TKI management. These findings highlight key areas for improvement in providing optimal care to patients with CML.

Citation

Milojkovic, D., Cross, N. C., Ali, S., Byrne, J., Campbell, G., Dignan, F. L., …Mead, A. J. (2021). Real‐world tyrosine kinase inhibitor treatment pathways, monitoring patterns and responses in patients with chronic myeloid leukaemia in the United Kingdom: the UK TARGET CML study. British Journal of Haematology, 192(1), 62-74. https://doi.org/10.1111/bjh.16733

• Journal Article Type: Article
• Acceptance Date: Apr 20, 2020
• Online Publication Date: May 24, 2020
• Publication Date: 2021-01
• Deposit Date: May 20, 2020
• Publicly Available Date: May 25, 2021
• Journal: British Journal of Haematology
• Print ISSN: 0007-1048
• Electronic ISSN: 1365-2141
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 192
• Issue: 1
• Pages: 62-74
• DOI: https://doi.org/10.1111/bjh.16733
• Keywords: Hematology
• Public URL: https://nottingham-repository.worktribe.com/output/4475314
• Publisher URL: https://onlinelibrary.wiley.com/doi/abs/10.1111/bjh.16733
• Additional Information: This is the peer reviewed version of the following article: Milojkovic, D., Cross, N.C.P., Ali, S., Byrne, J., Campbell, G., Dignan, F.L., Drummond, M., Huntly, B., Marshall, S., McMullin, M.F., Neelakantan, P., Raghavan, M., Sivakumaran, M., Tighe, J., Wandroo, F., Willis, F., Glen, F., Fildes, L., Collington, S.J., Ryan, J., Clark, R.E. and Mead, A.J. (2020), Real‐world tyrosine kinase inhibitor treatment pathways, monitoring patterns and responses in patients with chronic myeloid leukaemia in the United Kingdom: the UK TARGET CML study. Br J Haematol., which has been published in final form at https://doi.org/10.1111/bjh.16733. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.