Cases Of Chronic Myeloid Leukemia Research Articles

Hematological profile and its correlation with reverse transcription–polymerase chain reaction-based serial quantitative detection of BCR-ABL in chronic myeloid leukemia patients at a referral cancer center

Abstract BACKGROUND: There are variations in the hematological profile among the Indian population affected with chronic myeloid leukemia (CML). The range of white blood cell count (WBC) was 0.46 × 109/mm3 to 1.86 × 109/mm3. Similarly, range for hemoglobin was 9–11 g/dl. WBC count can be as low as 0.18 × 109/mm3 even though CML is a myeloproliferative disorder. OBJECTIVE: The objective of this study was to correlate BCR-ABL expression with the hematological and myeloid proliferative parameters. METHODS: The present study was a single-center, hospital-based follow-up study among 66 cases of CML. The sample of patients was analyzed for BCR-ABL gene expression; hematological parameters and myeloid proliferative parameters such as band forms, myelocytes, metamyelocytes, and blast were also measured. Some patients reported twice, some thrice, and the total count after all follow-up for all 66 cases was 179. RESULTS: The mean age was 43.15 years. Men were more than women with male-to-female ratio of 1.6:1. The mean hemoglobin was lesser at 10.8 g/dl. Median total count was normal at 5610 (interquartile range = 2750) per μl. Mean neutrophils, lymphocytes, monocytes, basophils, and platelets were normal. The eosinophil count was raised. The BCR-ABL gene expression was positively and significantly correlated with total count. It was negatively and significantly correlated with lymphocytes and monocytes. It was not correlated with other hematological parameters. All the myeloid proliferative parameters, namely, band forms, myelocytes, metamyelocytes, and blast, were positively and significantly correlated with BCR-ABL gene expression. CONCLUSION: Total count and all myeloid proliferative parameters were positively and significantly correlated with BCR-ABL gene expression. Lymphocytes and monocytes were negatively correlated. These parameters can be used to track the disease progression in patients with CML.

Rare case of Chronic Myeloid Leukemia (chronic phase) in pediatric age group: Diagnostic and pathological perspective

Rare case of Chronic Myeloid Leukemia (chronic phase) in pediatric age group: Diagnostic and pathological perspective

Ischemic stroke as a presenting feature of promyelocytic blast phase in chronic myeloid leukemia - an uncommon presentation: a case report and literature review in the post imatinib era.

Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm (MPN characterized by reciprocal translocation in the ABL1 and BCR region of chromosomes 9 and 22 respectively. Progression to the blast phase in chronic myeloid leukemia results in a poorer prognosis. It can be of either myeloid, lymphoid or a mixed lineage. Progression to the promyelocytic blast phase is very rare, and there are no evidence-based guidelines for its management. Thrombosis in CML is not well defined. Thrombosis can be seen in patients with acute promyelocytic leukemia (APL) with venous thrombosis (VTE) being more common than arterial thrombosis. Ischemic stroke as the presenting feature of blast phase progression in CML is extremely rare. We report a case of CML who presented to us with acute ischemic stroke and subsequently was diagnosed as CML transformed to the promyelocytic blast phase. She was successfully treated with dasatinib along with all-trans retinoic acid (ATRA) and arsenic trioxide (ATO).

Detection and Response Evaluation of Extramedullary and Medullary Blast Crisis in Chronic Myeloid Leukemia on 18F-FDG PET/CT.

FDG PET/CT imaging is usually not routinely undertaken in patients of chronic myeloid leukemia (CML). We present a case of CML on tyrosine kinase inhibitor treatment with disease control indicated by BCR-ABL1 quantitative reverse transcription-polymerase chain reaction, who underwent PET/CT for evaluation of recent onset vision deterioration with subretinal exudates on ophthalmological examination. PET CT detected FDG-avid sinonasal thickening and bilateral marrow lesions. These lesions on histopathological sampling, examination revealed extramedullary and intramedullary CML blast crisis. Patient was then treated with steroids and change of tyrosine kinase inhibitor for the CML blast crisis. FDG PET/CT done subsequently was able to demonstrate morphological and metabolic response in the lesions.

A Lethal Case of Chronic Myeloid Leukemia in Accelerated Phase Presenting in Labor

A Lethal Case of Chronic Myeloid Leukemia in Accelerated Phase Presenting in Labor

Varying concentrations of tyrosine kinase inhibitors in chronic myeloid leukemia patients following bariatric surgery: a case series

Bariatric surgery is increasingly performed to treat severe obesity. As a result of anatomical and physiological changes in the gastrointestinal tract, the pharmacokinetics (PK) of oral drugs can be altered, affecting their efficacy and safety. This includes the class of tyrosine kinase inhibitors (TKIs) which are used to treat chronic myeloid leukemia (CML). This case series describes the clinical course of four CML cases with a history of bariatric surgery. The patients used various TKIs (nilotinib, dasatinib, bosutinib, ponatinib, and imatinib) for which 15 drug levels were measured. The measured TKI concentrations were in part subtherapeutic, and highly variable when compared to mean levels measured in the general population. Multiple drug levels were measured in these patients, as the clinicians were aware of the possible impact of bariatric surgery. The drug levels were used as additional input for clinical decision-making. All four patients required TKI switches and/or dose modifications to achieve an effective and tolerable treatment. Eventually, adequate clinical and molecular remissions were achieved in all cases. In summary, TKI concentrations of patients undergoing bariatric surgery may be subtherapeutic. Moreover, there is substantial interindividual and intraindividual variation, which may be explained by the complex interference of bariatric surgery and associated weight loss. For clinical practice, therapeutic drug monitoring is advised in patients with a history of bariatric surgery in case of suboptimal response or loss of response.

Variant Philadelphia Chromosome in Nine Cases of Chronic Myeloid Leukemia: Experience of a Tertiary Care Hospital in Eastern India

Variant Philadelphia Chromosome in Nine Cases of Chronic Myeloid Leukemia: Experience of a Tertiary Care Hospital in Eastern India

An Extensive Analysis and Comparison of Bone Marrow Aspiration and Bone Marrow Trephine Biopsy at a Tertiary Care Hospital in Jharkhand for Various Hematological and Non-hematological Illnesses.

Background Bone marrow examination (BME) is an indispensable diagnostic tool to evaluate various hematological and non-hematological disorders. Bone marrow aspirate cytology and bone marrow trephine biopsy, even though performed simultaneously, are assessed at different points in time due to different processing methods. Aims and objective This study aims to assess and compare the role of bone marrow aspiration and trephine biopsy to formulate an effective and rapid method for diagnosing a wide spectrum ofvarious hematological and non-hematological disorders. Materials and methods The approach of our study was a hospital-based prospective study conducted on 200 patients over a period of 1 year. The role of bone marrow aspiration and a trephine biopsy is to formulate an effective and rapid method for diagnosing a wide spectrum of hematological and non-hematological disorders. Results In our study, a total of 200 cases were studied, of whom 119 patients were male and 81 were female. The most common finding was erythroid hyperplasia, comprising 40 (20%) cases, followed by hypoplastic marrow, comprising 28 (14%) cases. Subsequently, there were 19 (9.5%) cases of acute leukemia, while 15 (7.5%) cases of chronic myeloid leukemia (CML) in the chronic phase were found. In our study, bone marrow aspirate and bone marrow trephine biopsy were found to positively correlate in 137 (68.5%) of the cases. Conclusion Bone marrow aspiration alone is sufficient for the diagnosis of megaloblastic anemia and most of the hematological malignancies. Bone marrow trephine biopsy is more appropriate for the detection of disorders of focal marrow involvement such as lymphoproliferative disorders and staging of lymphomas, metastatic cancers, granulomatous lesions, and hypoplastic marrow. However, it is strongly recommended that both procedures should be done simultaneously to ensure maximum diagnostic accuracy.

Peripheral blood quantitation of CD26 positive leukemic stem cells as a predictor of tyrosine kinase inhibitor response in chronic myeloid leukemia.

Leukemic stem cells (LSCs) are the transcriptionally low/silent cells which are resistant to the tyrosine kinase inhibitor. These have been found to play a pivotal role in disease relapse in chronic myeloid leukemia (CML) cases. The present study evaluated the correlation of absolute CML-LSC count in the peripheral blood (PB) at diagnosis and achievement of major molecular response (MMR) at 12 months in patients of CML-CP. This was a prospective, observational, non-interventional single center study including newly diagnosed adult (>18 yrs) CML-CP patients. Absolute CD26 + CML-LSC quantification was done by multiparametric flow cytometry. Patients were treated with Imatinib treatment and subsequently monitored at 3-month intervals for BCR::ABL transcript levels. MMR was defined as a BCR::ABL1 transcript level of less than 0.1% on international scale. A total of 89 patients were enrolled in the study out of which 40.5% achieved MMR at 12 months. There was a significant difference in the median absolute CML-LSC count of the patients who achieved MMR at 12 months as compared to those who did not (58.5 vs 368.1 cells/μL; p value <0.001). Using a ROC analysis, a count of <165.69 CML LSC/μL was identified to have a sensitivity of 83.8% and specificity of 72.4%, in predicting the MMR at 12 months. Absolute CML-LSC count at diagnosis in the PB predicts the MMR achievement at 12 months. An absolute count of less than 165 cells/μL is highly predictive of achieving MMR at 12 months.

Expectations and outcomes of varying treatment strategies for CML presenting during pregnancy.

Diagnosing chronic myeloid leukaemia (CML) during pregnancy is rare. Tyrosine kinase inhibitors (TKIs) have traditionally been contraindicated owing to their teratogenicity. Management decisions should consider the risks to mother and foetus of uncontrolled disease and teratogenic medications. Further cases are required to build upon the paucity of current literature. We report 22 cases of CML diagnosed during pregnancy from 2002 to date. Twenty-one pregnancies resulted in healthy babies and one patient miscarried. Some patients remained untreated throughout pregnancy but the majority received one or both of interferon-α and leucapheresis. One patient was started on imatinib at Week 26, and one on hydroxycarbamide in the third trimester. We report haematological parameters during pregnancy to provide clinicians with realistic expectations of management. There were no fetal abnormalities related to treatment during pregnancy. Seventeen patients achieved at least major molecular response on first-line TKI. A diagnosis of CML during pregnancy can be managed without significant consequences for mother or child. Leucapheresis and interferon-α are generally safe throughout pregnancy. Despite having been avoided previously, there is growing evidence that certain TKIs may be used in particular circumstances during the later stages of pregnancy. Future work should aim to further elucidate this safety profile.

Chronic myeloid leukemia presenting with disc edema: A case report

The aim is to report a case of chronic myeloid leukemia (CML) in a 20-year-old female who initially presented with bilateral optic disc edema and headaches, and to raise awareness of uncommon causes of disc edema that could potentially be life-threatening. The patient first presented in June 2022 with blurry vision in the left eye, headache, and neck pain of 6 months duration. Initial examination revealed a young woman in no acute distress, with a blood pressure of 100/60 mm Hg and a body mass index of 26.98. Her pinhole visual acuity was 6/9 in both eyes, extraocular motility was full bilaterally, and both pupils were briskly reactive. However, she had bilateral optic disc edema. Both brain and orbital magnetic resonance imaging (MRI) revealed normal findings. Serological tests for syphilis and human immunodeficiency virus were negative. Based on these and the clinical features, an initial diagnosis of idiopathic intracranial hypertension was made, and the patient was started on acetazolamide tablets. She was followed up for approximately 1 year without resolution of symptoms. At a follow-up visit in December 2023, she was found to have developed dilated tortuous vessels with discrete retinal lesions. A peripheral blood film result showed that the patient had CML. In conclusion, a high index of suspicion should be entertained when managing a patient with unexplained bilateral disc swelling with normal brain MRI study. A complete blood workup, including a peripheral blood film, should be included as a part of the routine investigation of these patients so that diagnosis and treatment could be instituted early.

Haematolymphoid Tumours Karyotypes: A Moroccan Population Retrospective Study from 1992 to 2021

Background: Haematolymphoid tumours are a heterogeneous group of pathologies involving cells of the haematopoietic lineage. Data reported here focus on the results of a descriptive, general, exclusive epidemiological study from a Moroccan population. Objective: Our research aimed to study the distribution of Haematolymphoid tumours in the regional context in Casablanca. Method: We focused on malignancies diagnosed between January 1992 and December 2021 at the Cytogenetics Department of the Pasteur institute of Morocco. Conventional karyotype analysis was performed on bone marrow samples from patients aged between 1 and 95 years and collected data were analyzed to perform statistical analyzes using SPSS20.0 software. Results: Of the karyotypes investigated 69.8% (1118/1601) were positive for haematolymphoid tumours. The mean age at diagnosis was 42.68 ± 18.20 years. The most frequent pathologies were myeloid neoplasms, with chronic myeloid leukaemia (CML) in first place at 69.8% (780/1118), followed by acute leukaemias (ALL, AML and ALAL) at 21.4% and myelodysplastic neoplasm (MDS) at 5.5%. The most recurrent clonal abnormalities were translocations t (9;22) with 74.2% in CML cases. Deletions 12.5% and additions 8% were found in all diseases with mainly trisomy’s 8 and 21 in AML and MDS and deletions in AML and ALAL. An association was also found in 12 cases of AML between t (8;21) translocation and sexual chromosome deletion (X and Y). The proportion of karyotype’s complexity (9.9%) seems to increase with ages. Conclusions: Haematolymphoid tumours occur at an earlier age in this cohort. Leukaemia represents the most frequent pathologies with a preponderance of chronic diseases, mainly affecting adults.

Clinical study of the efficacies of ruxolitinib plus low-dose PTCY for acute GVHD prevention after haploidentical transplantation in malignant hematological diseases

Objective: To investigate and verify a novel acute graft versus host disease (aGVHD) prevention protocol in the context of haploidentical hematopoietic stem cell transplantation (haplo-HSCT) . Methods: Patients who underwent haplo-HSCT in our center between January 2022 and December 2022 were included. All patients received reduced doses of cyclophosphamide, Rabbit anti-human tymoglobulin, ruxolitinib, methotrexate, cyclosporine, and MMF to prevent aGVHD. The transplantation outcomes, complications, and survival rate of all patients were investigated. Results: A total of 52 patients with haplo-HSCT were enrolled, 29 (55.8%) male and 23 (44.2%) female, with a median age of 28 (5-59) years. There were 25 cases of acute myeloid leukemia, 17 cases of acute lymphocyte leukemia, 6 cases of myelodysplastic syndrome, 2 cases of chronic myeloid leukemia and 2 cases of myeloproliferative neoplasms. 98.1% of patients had successful engraftment. The incidence of Ⅱ-Ⅳ aGVHD and Ⅲ-Ⅳ aGVHD was 19.2% (95% CI 8.2% -30.3% ) and 7.7% (95% CI 0.2% -15.2% ), respectively. No patients experienced severe gastrointestinal mucositis. The Epstein-Barr virus and CMV reactivation rates were 40.4% and 21.3%, respectively. 9.6% of patients relapsed during followup, with 1-year overall survival, progression-free survival, and non-relapse mortality rates of 86.5% (95% CI 76.9% -96.1% ), 78.8% (95% CI 67.4% -90.3% ) and 11.5% (95% CI 2.6% -20.5% ), respectively. Conclusion: Ruxolitinib combined with a low dose of PTCY is a safe and effective first-line aGVHD prevention strategy.

Novel Four-Way Variant Translocation, t(1;9;22;16)(q21;q34;q11.2;q24), in a Patient with Chronic Myeloid Leukemia

Chronic myeloid leukemia (CML) is characterized by the Philadelphia (Ph) chromosome resulting from the translocation of t(9;22)(q34;q11), producing the BCR::ABL1 fusion gene. Variant Ph chromosome translocations, involving rearrangements in chromosomes other than 9 and 22, occur in 5–10% of CML cases. Herein, we report a unique case of a 36-year-old male with a four-way variant Ph chromosome. Conventional chromosomal analysis performed on bone marrow aspirate samples showed 46, XY, t(1;9;22;16)(q21;q34;q11.2;q24). Nested RT-PCR of the BCR::ABL1 gene revealed a major BCR::ABL rearrangement. The treatment with nilotinib achieved a complete hematologic, cytogenetic, and molecular response after 12 months.

Bilateral Sudden Irreversible Hearing Loss in a Case of Chronic Myeloid Leukaemia: A Case Report.

Chronic myeloid leukemia is a type of blood cancer that affects the bone marrow and results in an overproduction of immature WBCs. The genetic mutation that causes CML is the BCR-ABL fusion gene. Adolescents are rarely affected. The case study aims to discuss a rare case of chronic myeloid leukemia causing bilateral hearing impairment, tinnitus, and vertigo. A 30-year-old female presented to the hospital in November, 2021, with sudden hearing impairment and other symptoms, leading to a CML diagnosis. Blood tests revealed hyperleukocytosis with marked neutrophilia, mild basophilia, and eosinophilia, and a BCR-ABL quantitation of 85%. Bone marrow aspiration showed granulocytic hyperplasia, mild left-shifted maturation, and less than 1% blasts. The patient was started with options including tyrosine kinase inhibitors (TKIs) such as Imatinib, which target the BCR-ABL fusion gene, reducing the number of leukemia cells and improving her white blood cell count. However, her deafness persisted, and she became dependent on hearing aids. CML presenting with hearing loss is rare, believed to be related to the infiltration of leukemic cells in the inner ear or microvascular complications. Treatment with tyrosine kinase inhibitors such as Imatinib can improve hematologic parameters, but the effect on hearing loss is uncertaint.

Patterns of chromosome abnormalities in a sample of Colombian patients with chronic myeloid leukemia

Chronic Myeloid Leukemia (CML) is characterized by the presence of the Philadelphia (Ph) chromosome, resulting from a translocation between chromosomes 9 and 22 that gives rise to the BCR-ABL1 fusion gene. The Ph chromosome is present in 95 % of CML cases. In 5 %-10 % of these cases Ph variants occur and, approximately 5 % of these cases present with additional chromosomal abnormalities (ACAs). In this work we describe the prevalence of chromosome abnormalities in a sample of Colombian CML patients. A descriptive cross-sectional study was conducted, analyzing cytogenetic and molecular data from 142 CML patients. Data were collected between 2016 and 2019 at the laboratory of Biogenética Diagnóstica S.A.S. Among the 142 patients were analyzed, 56 % were male, and the average age was 45 years. The Ph chromosome was observed in 81 % of the cases. Three-way chromosome variants involving chromosomes 3, 7, and 8 were detected. The most frequent additional chromosomal aberration was +der(22)t(9;22). Atypical patterns associated with poor prognosis were found, via FISH analyses, in 88.2 % of the patients. The BCR-ABL1 fusion gene was detected in 100 % of the 18 patients subjected RT-PCR tests. This retrospective study reveals intriguing findings regarding chromosomal abnormalities in Colombian patients with CML, including rare three-way chromosome variants and atypical FISH patterns associated with a poor prognosis.Further investigation is warranted to explore the clinical implications, prognosis, and survival outcomes associated with these cytogenetic findings in CML patients.

A Single Center Retrospective Study on the Efficacy of Haploidentical Hematopoietic Stem Cell Transplantation in Patients with Myeloid Neoplasms over 50 Years Old

Objective: This study aims to evaluate the efficacy and safety of haploidentical hematopoietic stem cell transplantation in patients with myeloid neoplasms over 50 years old, and to compare the differences in survival, recurrence, and adverse reactions between patients aged 50-55 and over 55 years old. Methods: The patients with myeloid neoplasms over 50 years old who received haploidentical hematopoietic stem cell transplantation from November 2016 to December 2021 in the Bone Marrow Transplantation Center of the First Affiliated Hospital, Zhejiang University, School of Medicine were enrolled. According to the age at the time of transplantation, patients were divided into Group A (50-55 years old) and Group B (≥ 55 years old). The differences in Overall survival (OS), progression free survival (PFS), non-relapse mortality (NRM), cumulative incidence of relapse (CIR), incidence of graft versus host disease (GVHD), and infection rate between the two groups were analyzed. Results: A total of 163 patients (group A, n=77; group B, n=86) were enrolled, including 112 cases of acute myeloid leukemia (AML), 39 cases of myelodysplastic neoplasms (MDS), 4 cases of chronic myeloid monocyte leukemia (CMML), 3 cases of primary myelofibrosis (MF), and 5 cases of chronic myeloid leukemia (CML). There were no statistically significant differences in baseline data between the two groups, including follow-up time, disease categories, HCT-CI score, remission status of AML patients, minimal residual lesion (MRD) level of AML patients, and IPSS-R score of MDS patients. However, more patients in Group A received myeloablative (MAC) conditioning than patients in Group B (92.2% vs 50%, P=0.000). The median follow-up time was 741 (7-2377) days. The overall 2-year OS is 73.0% ± 3.5%, 2-year PFS is 71.3% ± 3.6%, 2-year NRM is12.23%（7.65%-17.93%）, and 2-year CIR is 17.20%（11.64%-23.69%）. All patients in group A achieved hematopoietic reconstitution except one patient died of graft failure, while 5 patients of group B died of graft failure(P=0.126). Neutrophils and platelet reconstruction in Group B was slightly longer than in Group A. The neutrophils reconstruction occurred at a median of 12 (8-20) day and 13 (9-25) day, respectively (P=0.007), and platelet reconstruction occurred at a median of 12 (9-28) day and 13 (8-37) day, respectively (P=0.055). The 2-year OS of Group A and Group B was 76.6% ± 4.8% and 69.0 ± 5.1%, respectively (P=0.199); The 2-year PFS was 76.2% ± 4.9% and 66.9 ± 5.1%, respectively (P=0.236); The 2-year NRM was 9.16% (4.00% -16.96%) and 18.61% (11.18% -27.51%), respectively (P=0.094); The 2-year CIR was similar, with 14.66% (7.74% -23.67%) and 19.16% (11.48% -28.33%), respectively (P=0.782). Interestingly, there was a difference in NRM between patients receiving reduced-intensity (RIC) and MAC conditioning in Group B, which was 10.2% (3.69% -20.61%) and 25.58% (13.64% -39.34%), respectively (P=0.043), while there was no difference in CIR, which was 17.31% (7.88% -29.80%) and 18.90% (8.71% -32.06%), respectively (P=0.933). It is suggested that in older patients, the strength of conditioning regimen has a greater impact on NMR. The incidence of grade 3-4 aGVHD within 100 days in all patients was 11.84% (7.31% -17.56%), and the incidence of 2-year intensive cGVHD was 8.19% (4.58% -13.14%). The incidence of grade 3-4 aGVHD within 100 days was similar between the two groups, with 9.46% (4.13% -17.46%) and 14.10% (7.46% -22.81%) (P=0.368), respectively. The 2-year intensive cGVHD was 8.07% (3.26% -15.72%) and 8.28% (3.62% -15.42%) (P=0.890), with similar incidence rates. The incidence of bacterial septicemia, pneumonia, invasive fungal infection, herpes virus and other infections were similar in both groups. Univariate and multivariate analysis both showed that 50-55 years old was an independent protective factor of OS (2.384 (1070-5.312), P=0.034) and GRFS (2.683 (1.181-6.094), P=0.018) in AML patients. Conclusion: Haploidentical hematopoietic stem cell transplantation is an effective and safe treatment for myeloid neoplasms over the age of 50. Compared with patients aged 50 to 55 years old, patients with myeloid neoplasms aged over 55 years old had similar efficacy and safety. The impact of MAC and RIC pretreatment on the prognosis of patients at different ages may be different. This retrospective study is limited in number and needs more cases and prospective cohort study to further verify.

Real World Population- Based Data from Nationwide Registry Support the Existence of Accelerated Phase in Newly Diagnosed Chronic Myeloid Leukemia (CML) Patients Even in Tyrosine Kinase Inhibitors (TKIs) Era

Background For decades, CML has been considered to be a triphasic disease recognizing 3 distinct stages: chronic phase (CP), accelerated phase (AP), and blast crisis (BC). Since the discovery of TKIs, the prognosis of CML patients has rapidly improved and less than 10% of patients diagnosed in CP experience disease progression on the therapy. Based on low incidence of CML progression and the fact that CML biological behavior seems biphasic, the new WHO 2022 classification of CML deemed AP less relevant and suggested the omission of AP. Many experts, however, still advocate for its inclusion in CML classification (e.g. ELN 2020, ICC 2022, NCCN 2023), even though the universal definition of AP is not established and differs in between publications. Methods This retrospective, real-world study is based on the Czech nationwide CML registry INFINITY with the data of newly diagnosed CML patients who agreed and provided their written consent. Recruited subjects were adult patients diagnosed in years 2005 - 2022 with sufficient data to determine the phase of the disease at diagnosis and follow-ups to assess their overall survival (OS), disease specific survival (DSS) and progression-free survival (PFS). The phase of the disease at the time of diagnosis was determined using the classification according to ELN 2020, ICC 2022, WHO 2016, and WHO 2022. Whenever CP was established, EUTOS Long-Term Survival (ELTS) score was calculated, assigning the patient to low risk (LR), intermediate risk (IR) and high risk (HR) group. OS and PFS are defined according to published guidelines. DSS is defined as the time from diagnosis to death due to CML disease or CML treatment. Results During the studied time period, 1660 new cases of CML were reported in INIFINITY registry. Of them, 1500 patients had data sufficient to classify the phase of the disease at the time of the diagnosis according to ELN 2020 guidelines and WHO 2022 classification and 1395 patients had data to assess the phase according to WHO 2016 and ICC 2022 classifications. When using ELN 2020 guidelines, groups were assigned as follows: LR CP- 784 patients (52.3%), IR CP- 421 patients (28.1%), HR CP- 227 patients (15.1%), AP- 42 patients (2.8%), BC- 26 patients (1.7%). There were significant differences in representation by gender, age, comorbidities and performance score amongst patient groups. When comparing just HR CP and AP CML patients, there were no significant differences. Calculated estimates of 5- and 10- year OS, respectively, were 92.5% and 87.2% for LR CP, 83.5% and 65.9% for IR CP, 76.9% and 65.5% for HR CP, 59.2% and 45.9% for AP, and 32.9% for BC, p= 0.031 for HR CP versus AP (Figure 1). In the case of WHO 2016 and ICC 2022 classifications, 714 (51.2%) patients were diagnosed in LR CP, 374 (26.8%) in IR CP, 154 (11.0%) in HR CP, 125 (9.0%) in AP, and 28 (2.0%) in BC. Again, there were significant differences in representation by gender, age, comorbidities and performance score amongst patient groups. When comparing just HR CP and AP CML patients, only age at the time of diagnosis was significantly different. Calculated estimates of 5- and 10- year OS, respectively, were 93.2% and 87.5% for LR CP, 84.9% and 67.7% for IR CP, 80.0% and 69.5% for HR CP, 65.7% and 55.6% for AP, and 39.7% for BC. We also performed propensity score matching according to age for patients in HR CP and AP and calculated estimates of 5- and 10- year OS, respectively, were 85.4% and 74.4% for HR CP and 60.2%, and 52.0% for AP, p= 0.003 (Figure 2). Similar results were obtained when testing for PFS and DSS. Summary Real-world data obtained from 1500 patients diagnosed in Czechia over 17 years, in our opinion, support the need to recognize the existence of AP at the time of diagnosis, even though a singular definition of AP is not agreed upon. Patients in AP have worse survival scores (OS, DSS, PFS) compared to patients in CP and/or HR CP. Moreover, because ELTS risk score was calculated on patients in CP, it may not be suitable for patients in AP, which would be changed to CP according to the new WHO 2022 classification. In conclusion, based on the real-world data with long-term follow-up, we believe it would be reasonable to keep the AP as part of CML classification of newly diagnosed patients. This publication was supported by the grant number MUNI/A/1224/2022, Programme EXCELES, ID Project No. LX22NPO5102, and by the Ministry of Health of the Czech Republic grant number 00023736.

The Promising Third-Generation TKI Olverembatinib in Adult BCR::ABL1-Positive Acute Lymphoblastic Leukemia with T315I Mutation and Relapsed/Refractory Disease

Background Olverembatinib (HQP1351) is a novel third-generation tyrosine kinase inhibitor (TKI) that has shown remarkable efficacy and safety in chronic myeloid leukemia (CML). Still, few reports are available on BCR::ABL1-positive acute lymphoblastic leukemia (BCR::ABL1+ ALL). We first reported the early encouraging outcome of olverembatinib in BCR::ABL1+ ALL patients (pts) with T315I mutation or disease progression last year. Here, we enlarged the sample size and included a case of CML in lymphoid blast phase (CML-LBP) who also benefited from olverembatinib to a certain extent. Methods In this observational study, we retrospectively enrolled BCR::ABL1+ ALL or CML-LBP pts with T315I mutation, disease progression, or intolerant to previous TKIs in our institution from Dec. 2021 to May 2023. All pts received olverembatinib monotherapy (40mg qod) or combination therapy. Efficacy was assessed by CR rate, MRD negative (MRD &amp;lt;10 -4) rate by multiparameter flow cytometry (MFC), CMR (BCR-ABL1 transcript&amp;lt;10 -5) rate by RT-qPCR, as well as the survival data. PFS and OS were both calculated from the start of olverembatinib. Adverse events (AEs) were assessed and graded according to CTCAE v5.0. Results Totally, 30 pts with BCR::ABL1+ ALL (n=29) or CML-LBP (n=1) were analyzed. Among 29 BCR::ABL1+ ALL pts (median age of 60 years [range, 23-76]), 14 were in CR with molecular R/R disease, including 1 with MRD only detected by RT-qPCR. While the other 15 had hematological R/R disease, including 4 with central nervous system leukemia. T315I mutation was detected in 23 pts, including 8 with additional mutations. The baseline characteristics are detailed in Table 1. As for the 23-year-old female pt with CML-LBP, dasatinib was switched to olverembatinib when T315I, E255K, and E255V mutations were detected. T315I and E255V were eliminated rapidly after 1-month treatment of olverembatinib, while E255K still existed. At present, the patient maintained in CR, and blinatumomab will be used for MRD clearance before allo-HSCT. She was only included in the safety analysis. Among 14 pts with molecular R/R disease, 61.5% and 50% achieved MRD flow negativity and CMR with a median time of 1.3 months (range, 0.8-4.4) and 1.2 months (range, 0.9-4.4), respectively. Among 15 pts with hematological R/R disease, 80%, 53.3%, and 46.7% achieved CR/CRi, MRD flow negativity, and CMR, with a median time of 1 month (range, 0.2-2.5), 1 month (range, 0.2-3.3) and 2.1 months (range, 0.7-4.6), respectively. Totally, 8 pts underwent allo-HSCT with a median age of 48.5 years (range, 23-60), of which 6 pts achieved CMR before allo-HSCT, and all attained persistent CMR after allo-HSCT. By June 15, 2023, with a median follow-up time of 9.1 months (range, 1.7-16) in BCR::ABL1+ ALL pts, the median PFS was 7.8 months, and the median OS was not reached. For molecular R/R pts, the median PFS and OS were not reached, and for hematological R/R pts, the median PFS and OS were 6.5 and 8.6 months. MRD flow negativity or CMR responders had significantly better PFS and OS (PFS: p&amp;lt;0.001, p&amp;lt;0.001; OS: p&amp;lt;0.001, p&amp;lt;0.001), and bridging allo-HSCT after olverembatinib-based therapy showed a significant survival superiority (PFS: p=0.001; OS: p=0.017). Among the 23 pts with T315I mutation, the MRD flow negativity rate in pts with T315I single mutation was significantly higher than those with additional mutations (p=0.008), and the CMR rate tended to be better (p=0.089). Meanwhile, pts with T315I single mutation showed significant improvements in PFS and OS (Figure 1). As for safety analysis, the olverembatinib-based therapy was well-tolerated. Most non-hematological AEs were G1-2, and most G3-4 AEs were hematological, possibly related to chemotherapy. The incidence of G3-4 cardiovascular AEs was 6.7%. Five elderly pts (median age of 72 years [range, 63-76]) had temporary treatment suspension or dose reduction. No permanent discontinuation or death related to olverembatinib was observed. Conclusion This study further confirmed the efficacy of olverembatinib-based therapy in Chinese adults BCR::ABL1+ ALL pts with T315I mutation or R/R disease, especially in those with T315I single mutation. In addition, bridging allo-HSCT after deeper molecular remission could further improve survival. The safety profiles were manageable, but there is still a need to explore the optimal dose in elderly pts.

Incidence-Based Mortality Rates for Chronic Myeloid Leukemia (CML) in Adult US Populations By Gender and Race: The Aftermath of Tyrosine Kinase Inhibitors (TKIs)

Incidence-Based Mortality Rates For Chronic Myeloid Leukemia (CML) In Adult US Populations by Gender and Race: The Aftermath of Tyrosine Kinase Inhibitors (TKIs) Background: Chronic Myeloid Leukemia (CML) is one of the leading causes of Leukemia in North America and world wide. According to the American Cancer Society, 1 in 526 Americans will develop CML during their lifetime. CML accounts for about 15% of all new cases of leukemia. Estimates for new cases diagnosed in the United States in 2023 is about 8,930, with roughly 42% of these new cases in females and 58% in males. We looked at the incidence based mortality rates (probability of dying from) of CML by gender and race in adult populations in the United States from 2000-2019 via SEER.gov database. Methods: We used Incidence -Based Mortality SEER Research Data, 17 Registries, Nov 2021 Sub (2000-2019), which provides the broadest geographic coverage for incidence-based mortality rates and is roughly 26.5% of the US population (based on the 2020 Census) for the calculation of incidence rates of CML. SEER*Stat 8.4.1 was used to obtain age-adjusted rates for different age-groups, races and genders. We used Join-point software, version 5.0.2. by the National Cancer Institute, annually to create log-linear time trends. There are no P-values noted for the CI as Joinpoint does not currently produce a test statistic or p-value for Empirical Quantile confidence intervals. Results: Fig 1: CML Incidence Based Mortality Rate per 100,000 and age-adjusted to the 2000 US standard population for males and females 2000-2019 We identified a total of 1,183,747,806 diagnosed cases of CML between 2000-2019 among males and females in the United States. A dainty rise in the number of diagnosed cases was appreciated over the years, with 52,890,308 cases diagnosed in the year 2000 and 64,920,828 in the year 2019. The trend for CML among males show an increasing Incidence Based Mortality between 2000-2019 with an Average Annual Percent Change(AAPC) of 4.69%*CI 3.40 to 5.95), and 5.85%*(CI 4.54 to 8.35) in females. The AAPC for Whites, Black, American Indian/Alaska native and Asian or Pacific Islander were 5.51%* (95% CI 4.72 to 6.59), 2.03%*(95% CI 0.64 to 3.79), 3.12% (-2.15 to 10.78), and 2.42%*(95% CI 0.22 to 6.05) respectively. Conclusion: The denouement of our study shows a significant high rate of change in increasing incidence based mortality rate of CML in the US adult population from ages 20 years and older prior to 2002.The rate of change significantly drops after 2002, as noted in males, females and whites. Incidence based mortality was also noted to be significantly higher among males compared to females. Regarding race, the trend shows higher rates among whites and blacks compared to Asians or American Indians. The evidence points to some changes or events in or around the year 2002 that have significantly impacted the probability of dying from CML in the adult populations in the United States. This significant change coincides with the approval of Tyrosine Kinase inhibitors, with Imatinib (Gleevec) being the first one approved in 2001.