MPN-214: Chronic Myeloproliferative Neoplasms in Elderlies: Challenging Issues of Diagnosis and Treatment

Abstract

Context: Chronic myeloproliferative neoplasms (CMN) in elderlies are the frequently registered clonal stem cell malignancies, being characterized in the advanced phases by recurrent evolution and negative socio-economic sequels. OBJECTIVE: To assert the diagnosis and treatment options in elderlies with CMN. DESIGN: This clinico-analytic study included 78 elderly patients with chronic myeloid leukemia (CML), primary myelofibrosis (PMF) and polycythemia vera (PV), treated at the Institute of Oncology from Moldova between 1995–2020. The diagnosis was proved by histopathological, cytological, molecular examinations and FISH. SETTING: The follow-up and study were completed at the comprehensive cancer center. The study is related to the ambulatory and hospitalized care. PATIENTS: Prefibrotic PMF stage was confirmed in 8 (42.1%) cases, fibrotic stage – in 11 (57.9%). CML was proved in chronic phase in 25 (89.3%) patients, in the accelerated phase in 3 (10.7%). PV was diagnosed in stage IIA in 27 (87.1%) patients, in stage IIB in 4 (12.9%). INTERVENTIONS: TKIs were administered in the newly diagnosed CML patients, in cases of resistance to non-TKIs chemotherapy and interferon-α. PV and PMF patients were treated with busulfan, hydroxycarbamide and interferon-α, combined with phlebotomies in PV. RESULTS: There was no difference of the hematological response (HR) and molecular response rates under TKIs therapy between elderlies and CML totality. In patients ≥60 years 5-year overall survival (OS) was 69% after TKIs therapy, being slightly lower than in CML totality (74%). HR was achieved in all PV patients under chemotherapy and phlebotomies. In relapses, interferon-α provided HR for 61 and 79 months. 10-year OS of elderly PV patients constituted 76.4%, being lower than in PV totality (85.9%). There was no difference of the OS in elderlies under chemotherapy with busulfan and hydroxycarbamide. HR rate and OS were lower under busulfan and hydroxycarbamide treatment in PMF patients, than in PV. CONCLUSIONS: No difference of the OS was revealed in PV elderlies under busulfan and hydroxycarbamide therapy, surpassing the OS in PMF patients. TKIs therapy is a curable option for CML patients regardless the age. The OS in elderlies decays due to more frequent vascular-thrombotic events owing to thrombocytosis.