Quality of Life and Long-Term Therapy in Patients with Chronic Myeloid Leukemia

Abstract

Since the development of imatinib and other tyrosine kinase inhibitors (TKIs), the prognosis for patients with chronic myeloid leukemia (CML) has markedly improved, such that most patients diagnosed with CML can now expect to live with their disease rather than die from it. However, most patients will require long term treatment, which has deleterious effects on health-related quality of life. We review recent literature on drug-related adverse effects, long term medication adherence, limitations to fertility and pregnancy, effects on cognitive function, ability to work, financial toxicity, pediatric populations, and treatment discontinuation. While patients with CML are fortunate to have excellent therapies available to control their disease, many are unable to lead normal lives, which challenges the notion that research is no longer needed in CML. Curing CML, i.e., no detectable disease and no need for daily medications, should remain the ultimate goal.

Needs for information and reasons for (non)adherence in chronic myeloid leukaemia: Be aware of social activities disturbing daily routines

“…chronic myeloid leukaemia, medication adherence, medication information, patients' experiences, qualitative research, tyrosine kinase inhibitors effects including myelosuppression, rash, nausea, diarrhoea, fatigue, and musculoskeletal pain or myalgia. 5,6 The nature and frequency of these adverse effects varies depending on the TKI. TKI treatment is continued until progression of the disease.…”

Discontinuing Tyrosine Kinase Inhibitor Therapy in Chronic Myelogenous Leukemia: Current Understanding and Future Directions

“…Proton pump inhibitors are generally contraindicated in combination with TKIs, and medications associated with QT prolongation require increased ECG monitoring while receiving TKI M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT therapy. 12 This frequent monitoring and concern over concomitant medications can be both inconvenient and challenging for a patient. Moreover, long-term TKI therapy can be problematic for patients interested in conceiving.…”

Inferring immunological control mechanisms from TKI dose alterations in CML patients

“…As it appears unlikely that even a sustained remission truly indicates a complete eradication of the leukemic cells, other factors have to account for a continuing control of a minimal, potentially undetectable residual leukemic load. Although treatment discontinuation is highly desirable to reduce treatment-related side-effects and lower financial expenditures (16)(17)(18)(19), it is still not possible to prospectively identify those patients that are at risk for a molecular recurrence. Investigations of clinical markers and scores to predict the recurrence behavior of patients after the treatment cessation revealed that both TKI treatment duration and the duration of a DMR were also associated with a higher probability of TFR (11,15,20,21).…”