Abstract 4477

Tyrosine kinases Inhibitors (TKI) of first and second generation are presently the choice of treatment for chronic myeloid leukemia (CML) and adherence to the treatment is an important factor to obtain good therapeutic results. We used the World Health Organization adherence definition that enrolls a global person's behavior including how the medication is used, diet, and/or lifestyle change.

Objective:

To evaluate the adherence to TKI in patients with CML and to identify factors that can affect adherence to TKI treatment.

Methods:

A prospective and observational analysis was performed with 122 patients taking TKI, in a public institution. The median of observation time was 169 days (131-240). We used the Hasford scale to risk assessment of diagnosis. The adherence was calculated using the mean medication possession ratio (MPR), calculated as total days’ dose of TKI divided by the number of the days in the observation time. Statistical analysis began with descriptive analysis and after that we applied Pearson or Spearman's correlation and t-Test, what it is adequate, considering significant p-value £ 0.05.

Results:

A total of 122 patients were evaluated: 92 (75.5%) were taking Imatinib, 16 (13%) Nilotinib, 09 (7.5%) Dasatinib and 5 (4%) Bosutinib. The mean age was 48 (20-82) years. The majority of patients were male (61%) and the median of TKI treatment time was 45 months (7-114). There were 103 (84.5%) patients in first line treatment, 17 (14%) in second line and 2 (1.5%) in third line. Considering all patients, median and mean of adherence was 96% and 90% whereas 23% of patients had 100% of MPR. There was a significant difference between adherence distribution and cytogenetic results, best adherent patients had most complete and major cytogenetic response (p= 0.01) in CML Hasford lower risk group. In all patients, the MPR decreased with longer use of TKI treatment (p= 0.02) and with longer time of diagnosis (P= 0.002). The adherence was superior in patients participating in clinical trials (p= 0.01) and using second generation TKI (p= 0.001).

Conclusion:

The best adherence was correlated to a better cytogenetic response in Hasford lower risk group. Longer time of treatment was related to a poorer adherence, suggesting a continuous approach by health team can make a difference.

Disclosures:

No relevant conflicts of interest to declare.

Topics:
cytogenetics, leukemia, myelocytic, chronic, protein-tyrosine kinase inhibitor, risk reduction, bosutinib, dasatinib, diet, imatinib mesylate, nilotinib, phosphotransferases

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2010 by The American Society of Hematology
2010
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