Nilotinib efficacy, safety, adherence and impact on quality of life in newly diagnosed patients with chronic myeloid leukaemia in chronic phase: a prospective observational study in daily clinical practice

Br J Haematol. 2019 Dec;187(5):615-626. doi: 10.1111/bjh.16145. Epub 2019 Aug 8.

Abstract

This observational, prospective study assessed, in a daily clinical practice, the molecular response, safety, quality of life (QoL) and treatment adherence in 183 patients with chronic myeloid leukaemia in chronic phase (CML-CP), receiving nilotinib as first-line treatment. Premature study termination before 24 months of follow-up occurred in 61 patients (33·3%), and was essentially due to nilotinib treatment discontinuation (n = 53; 29%), motivated by treatment intolerance (n = 29; 15·8%) and inefficacy (n = 19; 10·4%). After 24 months of treatment, 112/122 patients (91·8%) had a molecular assessment, 95·5% of whom achieved a major molecular response (MMR), 32·1% achieved uMR4 , defined as an undetectable molecular disease with 4-log molecular response sensitivity (≥10 000 ABL1 transcripts). The Morisky Green Levine Medication Adherence Scale was completed by 94/122 patients (77·0%), and 89·4% of these patients obtained a satisfactory level of treatment adherence, defined as a score ≥3. Patients' QoL was good at baseline and stable during the follow-up period. The two most common nilotinib-related adverse events (AEs) were pruritus (14·8%) and asthenia (13·7%). Seven patients (3·8%) experienced at least one cardiovascular ischaemic AE. This French nationwide cohort study provides relevant information in daily clinical practice indicating that nilotinib is a valuable first-line treatment option for CML-CP patients.

Keywords: adherence; chronic myeloid leukaemia; daily clinical practice; nilotinib; tyrosine-kinase inhibitor.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / adverse effects
  • Antineoplastic Agents / therapeutic use*
  • Asthenia / chemically induced
  • Biomarkers, Tumor / genetics
  • Drug Eruptions / etiology
  • Female
  • Follow-Up Studies
  • Fusion Proteins, bcr-abl / genetics
  • Humans
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / drug therapy*
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / genetics
  • Male
  • Medication Adherence / statistics & numerical data
  • Middle Aged
  • Prospective Studies
  • Protein-Tyrosine Kinases / antagonists & inhibitors
  • Pruritus / chemically induced
  • Psychometrics
  • Pyrimidines / adverse effects
  • Pyrimidines / therapeutic use*
  • Quality of Life*
  • Treatment Outcome
  • Young Adult

Substances

  • Antineoplastic Agents
  • BCR-ABL1 fusion protein, human
  • Biomarkers, Tumor
  • Pyrimidines
  • Protein-Tyrosine Kinases
  • Fusion Proteins, bcr-abl
  • nilotinib