Chronic Myeloid Leukemia Patient Registry in the Russian Federation: From Observational Studies to the Efficacy Evaluation in Clinical Practice

MYELOID TUMORS , , ,

AG Turkina1, NV Novitskaya2, AK Golenkov3, VA Shuvaev4, LI Napso5, IV Krylova6, AM Savrilova7, GSh Safuanova8, AV Korobkin9, TYu Klitochenko10, EV Burnasheva11, EV Vasil’ev12, OM Senderova13, EYu Fedorova14, LM Yalunina15, EK Nekhai16, GB Kuchma17, AS Lyamkina18, NG Shchedrova19

1 Hematology Research Center, 4а Novyi Zykovskii pr-d, Moscow, Russian Federation, 125167

2 SP Botkin Municipal Clinical Hospital, 5 2-i Botkinskii pr-d, Moscow, Russian Federation, 125284

3 NF Vladimirskii Moscow Regional Research Clinical Institute, 61/2 Shchepkina str., Moscow, Russian Federation, 129110

4 Russian Research Institute of Hematology and Transfusiology, 16 2-ya Sovetskaya str., Saint Petersburg, Russian Federation, 191024

5 Clinical Oncology Dispensary No. 1, 146 Dimitrova str., Krasnodar, Russian Federation, 350040

6 Sverdlovsk Regional Clinical Hospital No. 1, 185 Volgogradskaya str., Ekaterinburg, Russian Federation, 620102

7 Republican Clinical Hospital, 138 Orenburgskii trakt, Kazan’, Russian Federation, 420064

8 GG Kuvatov Republican Clinical Hospital, 132 Dostoevskogo str., Ufa, Russian Federation, 450005

9 Chelyabinsk Regional Clinical Hospital, 70 Vorovskogo str., Chelyabinsk, Russian Federation, 454076

10 Volgograd Regional Clinical Oncology Dispensary, 78 Zemlyachki str., Volgograd, Russian Federation, 400138

11 Rostov State Medical University, 29 Nakhichevanskii per., Rostov-na-Donu, Russian Federation, 344022

12 Regional Clinical Hospital, 3A Partizana Zheleznyaka str., Krasnoyarsk, Russian Federation, 660022

13 Irkutsk Order of the Badge of Honor District Clinical Hospital, 100 Yubileinyi microdistrict, Irkutsk, Russian Federation, 664049

14 VD Seredavin Samara Regional Clinical Hospital, 159 Tashkentskaya str., Samara, Russian Federation, 443095

15 SV Belyaev Kemerovo Regional Clinical Hospital, 22 Oktyabr’skii pr-t, Kemerovo, Russian Federation, 650066

16 Regional Clinical Hospital No. 2, 55 Russkaya str., Vladivostok, Russian Federation, 690105

17 Orenburg Regional Clinical Hospital No. 1, 5/3 Tsvillinga str., Orenburg, Russian Federation, 460006

18 Novosibirsk State Medical University, 52 Krasnyi pr-t, Novosibirsk, Russian Federation, 630091

19 Novartis Pharma, 72 bld. 3, Leningradskii pr-t, Moscow, Russian Federation, 125315

For correspondence: Anna Grigor’evna Turkina, DSci, Professor, 4а Novyi Zykovskii pr-d, Moscow, Russian Federation, 125167; e-mail: turkianna@yandex.ru

For citation: Turkina AG, Novitskaya NV, Golenkov AK, et al. Chronic Myeloid Leukemia Patient Registry in the Russian Federation: From Observational Studies to the Efficacy Evaluation in Clinical Practice. Clinical oncohematology. 2017;10(3):390–401 (In Russ).

DOI: 10.21320/2500-2139-2017-10-3-390-401

ABSTRACT

Background. Due to the significant increase in life expectancy and the quality of life in patients with chronic myeloid leukemia (CML) as well as the growing need for expensive tyrosine kinase inhibitors (TKI), the analysis of cost-effectiveness and lifelong monitoring of patients is especially important.

Aim. We present the results of a multicenter observational study “The Russian Registry of Chronic Myeloid Leukemia in routine clinical practice (2011–2016)”.

Materials & Methods. The study included Russian patients with CML, confirmed by the detection of a Ph-chromosome or a BCR-ABL transcript. The statistical analysis (July 1, 2016) included 7609 patients from 80 regions of the Russian Federation (covering 95 % of the population). The annual increase in the number of patients with newly diagnosed CML was 600–650 patients. At the time of the statistical analysis, 6995 (92 %) patients remained under observation, 473 (6 %) died and 141 (2 %) were withdrawn. The registry included 44 % of men and 56 % of women, the median age was 49 years (range 2–94 years). The peak incidence (46.3 %) occurred at the age of 40–60 years. The median disease duration by the time of the analysis was 6 years (range 0.1–30 years).

Results. The disease was diagnosed in the chronic phase (CP), acceleration phase, and blast crisis in 6560 (93.8 %), 380 (5.5 %) and 47 (0.7 %) patients, respectively. The proportion of risk groups according to Sokal for low, intermediate and high risk in CP was 49 %, 30 %, and 21 %, respectively. TKI were administered to 6473 (92.5 %) patients. Imatinib and the second generation TKI (TKI2) were administered to 5570 (86 %) and 903 (14 %) patients, respectively. The total of 30.4 % of patients received the increased imatinib dose of 600–800 mg. In the TKI2 group, 558 (61.7 %) patients received nilotinib and 345 (38.2 %) patients received dasatinib. The proportion of patients with completed molecular genetic studies (MGS) in 2014, 2015 and the first 6 months of 2016 amounted to 61 %, 58 % and 23 %, respectively. The proportion of patients with cytogenetic studies (CS) for the same period was 28 %, 26 % and 7 %, respectively. No CS or MGS data were presented for 34 %, 35 % and 63 % of patients during this period. Optimal molecular response and major molecular response (MMR) for TKI therapy were observed in 23 % and 58 % of patients treated < 12 months and > 12 months, respectively. When nilotinib was used in the second line, MMR was obtained in 42 % of patients, and a deep molecular response was obtained in 25 % of patients (BCR-ABL < 0.01 %).

Conclusion. The high efficacy of TKI therapy was observed in the majority of patients with the possibility of achieving a minimal residual disease. The problems concerning untimely monitoring and suboptimal administration of second line treatment were identified. In general, the CML patient registry allowed the data integration of data and information management of population with CML in Russia.

Keywords: chronic myeloid leukemia, registry, tyrosine kinase inhibitors, imatinib, nilotinib, quality of medical care.

Received: January 17, 2017

Accepted: April 27, 2017

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REFERENCES

  1. Hehlmann R, Hochhaus A, Baccarani M. Chronic myeloid leukaemia. Lancet. 2007;370(9584):342–50. doi: 10.1016/s0140-6736(07)61165-9.
  2. Зарицкий А.Ю., Ломайа Э.Г., Виноградова О.Ю. и др. Результаты многоцентрового исследования терапии гливеком больных хроническим миелолейкозом в хронической фазе. Гематология и трансфузиология. 2007;52(2):13–7.
    [Zaritskii AYu, Lomaia EG, Vinogradova OYu, et al. Results of multi-center study of gleevek therapy of patients with chronic myeloid leukemia in the chronic phase. Gematologiya i transfuziologiya. 2007;52(2):13–7. (In Russ)]
  3. Kantarjian H, O’Brien S, Jabbour E, et al. Improved survival in chronic myeloid leukemia since the introduction of imatinib therapy: a single-institution historical experience. Blood. 2012;119(9):1981–7. doi: 10.1182/blood-2011-08-358135.
  4. Виноградова О.Ю. Клиническая эволюция хронического миелолейкоза в процессе лечения ингибиторами тирозинкиназ. Дис. … д-ра мед. наук. М., 2011.
    [Vinogradova OYu. Klinicheskaya evolyutsiya khronicheskogo mieloleikoza v protsesse lecheniya ingibitorami tirozinkinaz. (Clinical evolution of chonic myeloid leukemia in patients receiving tyrosine kinase inhibitors.) [dissertation] Moscow; 2011. (In Russ)]
  5. Лазарева О.В., Туркина А.Г., Гусарова Г.А. и др. Итоги 12-летней терапии ингибиторами тирозинкиназ больных в поздней хронической фазе хронического миелолейкоза после неудач лечения ИФН-α. Сибирский научный медицинский журнал. 2015;35(1):90–7.
    [Lazareva OV, Turkina AG, Gusarova GA, et al. The results of 12 years treatment of patients in late chronic phase of chronic myeloid leukemia by tyrosine kinase inhibitors after failure IFN-α. Sibirskii nauchnyi meditsinskii zhurnal. 2015;35(1):90–7. (In Russ)]
  6. Шухов О.А. Молекулярная и цитогенетическая характеристика Ph-позитивного клона у больных хроническим миелолейкозом при длительном воздействии ингибиторов тирозинкиназ. Дис.… канд. мед. наук. М., 2015.
    Shukhov OA. Molekulyarnaya i tsitogeneticheskaya kharakteristika Ph-pozitivnogo klona u bol’nykh khronicheskim mieloleikozom pri dlitel’nom vozdeistvii ingibitorov tirozinkinaz. (Molecular and cytogenetic characteristics of Ph-positive chronic myeloid leukemia after long-term treatment with tyrosine kinase inhibitors.) [dissertation] Moscow; 2015. (In Russ)]
  7. Hochhaus A, Larson RA, Guilhot F, et al. Long-Term Outcomes of Imatinib Treatment for Chronic Myeloid Leukemia. N Engl J Med. 2017;376(10):917–27. doi: 10.1056/NEJMoa1609324.
  8. Baccarani M, Deininger MW, Rosti G, et al. European LeukemiaNet recommendations for the management of chronic myeloid leukemia: 2013. Blood. 2013;122(6):872–84. doi: 10.1182/blood-2013-05-501569.
  9. Туркина А.Г., Челышева Е.Ю. Стратегия терапии хронического миелолейкоза: возможности и перспективы. Терапевтический архив. 2013;85(7):4–9.
    [Turkina AG, Chelysheva EYu. Therapeutic strategy for chronic myeloid leukemia: possibilities and prospects. Terapevticheskii arkhiv. 2013;85(7):4–9. (In Russ)]
  10. Branford S, Seymour JF, Grigg A, et al. BCR-ABL messenger RNA levels continue to decline in patients with chronic phase chronic myeloid leukemia treated with imatinib for more than 5 years and approximately half of all first-line treated patients have stable undetectable BCRABL using strict sensitivity criteria. Clin Cancer Res. 2007;13(23):7080–5. doi: 10.1158/1078-0432.CCR-07-0844.
  11. Hochhaus A, Saglio G, Hudges TP, et al. Long-term benefits and risks of frontline nilotinib vs imatinib for chronic myeloid leukemia in chronic phase: 5-year update of the randomized ENESTnd trial. Leukemia. 2016;30(5):1044–54. doi: 10.1038/leu.2016.5.
  12. Cortes JE, Saglio G, Kantarjian HM, et al. Final 5-year study results of DASISION: the dasatinib versus imatinib study in treatment-naive chronic myeloid leukemia patients Trial. J Clin Oncol. 2016;34(20):2333–40. doi: 10.1200/JCO.2015.64.8899.
  13. Mahon FX, Rea D, Guilhot J, et al. Discontinuation of imatinib in patients with chronic myeloid leukaemia who have maintained complete molecular remission for at least 2 years: the prospective, multicentre Stop Imatinib (STIM) trial. Lancet Oncol. 2010;11(11):1029–35. doi: 10.1016/S1470-2045(10)70233-3.
  14. Ross DM, Branford S, Seymour JF, et al. Safety and efficacy of imatinib cessation for CML patients with stable undetectable minimal residual disease: results from the TWISTER study. Blood. 2013;122(4):515–22. doi: 10.1182/blood-2013-02-483750.
  15. Saussele S, Richter J, Hochhaus A, et al. The concept of treatment-free remission in chronic myeloid leukemia. Leukemia. 2016;30(8):1638–47. doi: 10.1038/leu.2016.115.
  16. Hughes TP, Ross DM. Moving treatment-free remission into mainstream clinical practice in CML. Blood. 2016;128(1):17–23. doi: 10.1182/blood-2016-01-694265.
  17. Куликов С.М., Виноградова О.Ю., Челышева Е.Ю. и др. Заболеваемость хроническим миелолейкозом в 6 регионах России по данным популяционного исследования 2009–2012 гг. Терапевтический архив. 2014;86(7):24–30.
    [Kulikov SM, Vinogradova OYu, Chelysheva EYu, et al. Incidence of chronic myeloid leukemia in 6 regions of Russia according to the data of the 2009–2012 population-based study. Terapevticheskii arkhiv. 2014;86(7):24–30. (In Russ)]
  18. Лазарева О.В., Туркина А.Г., Челышева Е.Ю. и др. Клинико-гематологическая характеристика больных при диагностике хронического миелолейкоза: Анализ российских данных в рамках международного популяционного исследования (Population Bases Study). Гематология и трансфузиология. 2016;61(1 Suppl 1):136–7.
    [Lazareva OV, Turkina AG, Chelysheva EYu, et al. Clinical and hematological characteristics of patients in diagnosis of chronic myeloid leukeima: analysis of Russian data of Population Based Study. Gematologiya i transfuziologiya. 2016;61(1 Suppl 1):136–7. (In Russ)]
  19. Туркина А.Г., Голенков А.К., Напсо Л.И. и др. Российский регистр по лечению хронического миелоидного лейкоза в рутинной клинической практике: итоги многолетней работы. Эффективная фармакотерапия. Онкология, гематология и радиология. 2015;1(10):10–3.
    [Turkina AG, Golenkov AK, Napso LI, et al. Chronic myeloid leukemia Russian register in routine clinical practice: results of the multi-year work. Effectivnaya farmakoterapiya. Onkologiya, gematologiya i radiologiya. 2015;1(10):10–3. (In Russ)]