Abstract：
Tyrosine kinase inhibitors (TKIs) have greatly improved chronic myeloid leukemia (CML) treatments, with survival rates close to the general population. Yet, for the very elderly, robust data remains limited. This study focused on assessing comorbidities, treatment approaches, responses, and survival for elderly CML patients. Our study was conducted on 123 elderly (≥ 75 years) CML patients across four centers in Israel and Moffitt Cancer Center, USA. The median age at diagnosis was 79.1 years, with 44.7% being octogenarians. Comorbidities were very common; cardiovascular risk factors (60%), cardiovascular diseases (42%), with a median age-adjusted Charlson Comorbidity Index (aaCCI) of 5. Imatinib was the leading first-line therapy (69%), while the use of second-generation TKIs increased post-2010. Most patients achieved a major molecular response (MMR, 66.7%), and half achieved a deep molecular response (DMR, 50.4%). Over half (52.8%) of patients moved to second-line, and nearly a quarter (23.5%) to third-line treatments, primarily due to intolerance. Overall survival (OS) was notably longer in patients with an aaCCI score below 5, and in patients who attained DMR. Contrary to expectations, the Israeli cohort showed a shorter actual life expectancy than projected, suggesting a larger impact of CML on elderly survival. In summary, imatinib remains the main initial treatment, but second-generation TKIs are on the rise among elderly CML patients. Outcomes in elderly CML patients depend on comorbidities, TKI type, response, and age, underscoring the need for personalized therapy and additional research on TKI effectiveness and safety.
摘要：
酪氨酸激酶抑制剂（TKIs）大大改善了慢性粒细胞白血病（CML）的治疗，生存率接近普通人群。然而，对于老年人来说，稳健的数据仍然有限。这项研究的重点是评估合并症，治疗方法,回应,老年慢性粒细胞白血病患者的生存率。我们的研究是针对以色列四个中心和Moffitt癌症中心的123名老年（≥75岁）CML患者进行的。美国。诊断时的中位年龄为79.1岁，44.7%是八十岁老人。合并症非常常见；心血管危险因素(60%)，心血管疾病（42%），年龄调整后的Charlson合并症指数（aaCCI）中位数为5。伊马替尼是领先的一线疗法（69％），而第二代TKIs的使用在2010年后有所增加。大多数患者达到了主要的分子反应（MMR，66.7%），一半实现了深层分子反应(DMR，50.4%）。超过一半(52.8%)的病人转到二线，近四分之一(23.5%)接受三线治疗，主要是因为不宽容。aaCCI评分低于5的患者和获得DMR的患者的总生存期（OS）明显更长。与预期相反,以色列队列显示实际预期寿命比预期短，表明CML对老年人生存有较大影响。总之,伊马替尼仍然是主要的初始治疗，但第二代TKIs在老年CML患者中呈上升趋势.老年CML患者的预后取决于合并症，TKI类型,回应,和年龄,强调需要个性化治疗和对TKI有效性和安全性的额外研究。
