Diagnosis and Management of Chronic BCR-ABL-Positive and BCR-ABL-Negative Myeloproliferative Neoplasms in Elderly Patients: An Approach towards Hematologic Oncology and Public Health

Abstract

Background: Chronic myeloproliferative neoplams (CMN) are totally the most common chronic leukemias among the elderly persons in the structure of morbidity by hematologic malignancies with primary bone marrow involvement, being characterized in the advanced stages by a severe, relapsing evolution and unfavorable prognosis, with negative socio-economic impact. Objectives of the Study: Evaluation of the diagnosis and management options in chronic BCR-ABL-positive and BCR-ABL-negative myeloproliferative neoplasms in elderly patients in order to upgrade an approach to hematologic oncology care. Material and Methods: A clinico-analytical, descriptive, prospective-retrospective study was accomplished along with the narrative review of the international literature on the subject. The study included 91 elderly patients with chronic myeloid leukaemia (CML), primary myelofibrosis (PMF), and polycythemia vera (PV) who were followed and treated at the Institute of Oncology from 1995 to 2021. In regard to the impact scale, 29 relevant primary sources were distinguished and selected with a scientific, reproducible and transparent approach to the subject under discussion, followed by the data extraction and analysis. Results: Thirty-four (37.3%) patients with PMF, 26 (28.6%) – with CML and 31 (34.1%) – with PV were diagnosed in the elderly age groups and followed up by our study. The age group of 60-69 years dominated in CML (22 cases or 84.6%), constituting 25 (80.6%) cases in PV, and 25 (73.5%) - in PMF. The one- and 5-year overall survival (OS) in CML patients aged greater than or equal to 60 years treated with tyrosine kinase inhibitors (TKIs) was 97.6% and 79.8%, being lower as compared with the same indicators in the totality of CML. In elderly PV patients the OS over one year constituted 100%, over 5 years – 93.5%, over 10 years – 76.4%, being lower within 5-10 years than those registered in all patients with PV (over one year – 100%, 5 years – 98.6%, 10 years – 85.9%). Although the relapse rate was lower in patients treated with busulfan as compared to those managed with hydroxycarbamide, there was no significant difference in the OS of the elderly PV patients undergoing chemotherapy with these antineoplastic agents. As stipulated in the recent bibliographic databases, a significant rate of patients with CMN experienced the reduced work hours, discontinued employment, and medical disability: PMF – 38%, 35%, 33%, and PV – 33%, 28%, and 15%, respectively. Conclusions: The long-term results of treatment in elderly patients with CMN proved to be inferior to those in CMN totality because of the development of age-related diseases and vascular events on the account of the increased values of leukocytes and platelets. The targeted treatment with TKIs remains a first-line management option for CML patients of 60 years and more. In the elderly PV patients no significant difference was revealed in short- and long-term outcomes of chemotherapy with busulfan and hydroxycarbamide in combination with phlebotomy, being totally superior to those in PMF patients.