Real-World Management of Chronic Myelogenous Leukemia in an Underserved Patient Cohort at a Los Angeles Safety-Net Health System: Tyrosine Kinase Inhibitor Treatment Patterns and Outcomes From 2015 to 2024.
While overall survival for chronic myeloid leukemia (CML) at 5 years now exceeds 90% with modern tyrosine kinase inhibitor (TKI) therapies, disparities in management and outcomes persist among underserved populations. This study describes TKI treatment patterns and outcomes in a predominantly Hispanic, underserved CML cohort treated at Los Angeles County safety-net hospitals.
We performed a retrospective chart review of 108 adult patients with CML who presented to Los Angeles County hospitals between 2015 and 2024. Data collected included demographics, comorbidities, treatment selection per line of therapy (LOT), and major molecular response (MMR; > 3-log reduction) rates.
The majority (58.3%) of patients were Hispanic, and most (59.2%) lived in zip codes with household incomes below the national average. The median age at diagnosis was 46 years old, and 82.4% of patients had comorbid conditions at diagnosis, including elevated BMI (67.5%), hypertension (28.7%), and diabetes (20.4%). By EUTOS score, 55.6% of patients were low-risk, and 11.1% were high-risk. Imatinib was the most common first-line treatment for 64.8% of patients, followed by 31.5% with dasatinib. MMR was achieved in 44.4% of patients, while 43.5% of patients discontinued first-line LOT due to medication intolerance. Overall, 56.5% of patients progressed to second LOT and 27% required third LOT.
Despite a younger median age at diagnosis, our patients had less favorable outcomes compared to previously published cohorts including lower rates of MMR with first-line therapy, higher rates of toxicity, and needing more lines of therapy overall. These findings highlight the need for further investigation into the socioeconomic, biologic, and treatment-access factors impacting outcomes in underserved patients with CML.
We performed a retrospective chart review of 108 adult patients with CML who presented to Los Angeles County hospitals between 2015 and 2024. Data collected included demographics, comorbidities, treatment selection per line of therapy (LOT), and major molecular response (MMR; > 3-log reduction) rates.
The majority (58.3%) of patients were Hispanic, and most (59.2%) lived in zip codes with household incomes below the national average. The median age at diagnosis was 46 years old, and 82.4% of patients had comorbid conditions at diagnosis, including elevated BMI (67.5%), hypertension (28.7%), and diabetes (20.4%). By EUTOS score, 55.6% of patients were low-risk, and 11.1% were high-risk. Imatinib was the most common first-line treatment for 64.8% of patients, followed by 31.5% with dasatinib. MMR was achieved in 44.4% of patients, while 43.5% of patients discontinued first-line LOT due to medication intolerance. Overall, 56.5% of patients progressed to second LOT and 27% required third LOT.
Despite a younger median age at diagnosis, our patients had less favorable outcomes compared to previously published cohorts including lower rates of MMR with first-line therapy, higher rates of toxicity, and needing more lines of therapy overall. These findings highlight the need for further investigation into the socioeconomic, biologic, and treatment-access factors impacting outcomes in underserved patients with CML.
Authors
Zheng Zheng, Nold Nold, Ramakrishnan Ramakrishnan, Kim Kim, Tomassetti Tomassetti
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