Impact of socio-demographic co-variates on prognosis, tyrosine kinase-inhibitor use and outcomes in persons with newly-diagnosed chronic myeloid leukaemia

Abstract

Purpose: Define the impact of socio-demographic co-variates on outcomes of persons with newly-diagnosed chronic phase chronic myeloid leukaemia (CML).

Methods: Data of 961 consecutive subjects with newly-diagnosed CML were integrated for these outcomes in multi-variable Cox regression analyses after adjusting for confounders and interactions.

Results: Elder age was associated with less use of a 2nd generation TKI as initial therapy. Household registration, comorbidity(ies) and education level were associated with use of a generic rather than branded TKI as initial therapy. Subjects with lower education level were more likely to be diagnosed with CML because of leukaemia-related symptoms. Rural registration and lower education level were also associated with a greater likelihood of switching TKI-therapy. Lower education level was associated with lower likelihood of achieving MMR [HR = 0.8 (0.7, 0.9), p = 0.002], MR^4.5 [HR = 0.8 (0.7, 1.0), p = 0.055], and poor FFS [HR = 1.7 (1.3, 2.5); p < 0.001], PFS [HR = 2.0 (1.1, 5.0); p = 0.014], CML-related survival [HR = 2.5 (1.0, 10.0); p = 0.060] and survival [HR = 2.5 (1.0, 10.0); p = 0.043]. Males had lower rates of MMR and MR^4.5 and worse FFS, but not survival compared with females. Being married was associated with a higher rate of MR^4.5, fewer failures, progressions, and deaths.

Conclusion: Socio-demographic co-variates have a strong impact on therapy choice and responses in persons with newly-diagnosed CML, including circumstances of diagnosis, risk category and prognosis, use of initial TKI, switching TKIs, response to TKI-therapy, and outcomes.

Keywords: Chronic; Leukaemia; Myeloid; Socio-demographic co-variates; Tyrosine kinase inhibitor.

Fig. 1

TKI-use. a Initial TKI; b TKI at last follow-up

Fig. 2

ELTS risk at diagnosis by socio-demographic co-variates

Fig. 3

Responses and outcomes by socio-demographic co-variates. a, b, MMR and MR^4.5 by sex; c, MR^4.5 by marital state; d and e, MMR and MR^4.5 by education level; f, FFS by sex; g, h, i, FFS, PFS and survival by marital state; j, k, l, m, FFS, PFS, survival and CML-related survival by education level