title: Charlson comorbidity index and adult comorbidity evaluation-27 scores might predict treatment compliance and development of pleural effusions in elderly patients with chronic myeloid leukemia treated with second-line dasatinib.
abstract: BACKGROUND
  Comorbidities may affect survival and choice of treatment among cancer patients. In fact, comorbidities have been identified as significant determinants of response to therapy in older patients with acute myeloid leukemia, breast cancer, head and neck cancer, and lung cancer. The Charlson comorbidity index and adult comorbidity evaluation-27 are lists of comorbidities with a weight assigned from 1 to 6 for the former and from 0 to 3 for the latter score, derived from relative risk estimates of a proportional hazard regression model using clinical data.
  
  
  METHODS
  We retrospectively evaluated the Charlson index and adult comorbidity evaluation-27 score in a cohort of 125 elderly (> 60 years) patients with chronic phase chronic myeloid leukemia who received dasatinib after showing resistance or intolerance to imatinib with the aim of establishing associations between comorbidities and the development of pleural effusions or compliance with the drug treatment.
  
  
  RESULTS
  We found a significant association between the Charlson index as well as the adult comorbidity evaluation-27 score and the rate of drug reduction or suspension: with regards to the Charlson index, 49% of score 0 patients had a dose reduction compared to 63% of patients with score 1, 74% of those with score 2 and 100% of patients with score 3-5 (P=0.03); with regards to the adult comorbidity evaluation-27 score, 45% of patients had score 0-1 and 69% of patients with score 2-3 had a dose reduction. Of the 65 patients with Charlson score 0, 29% had at least one suspension of treatment (79% for hematologic and 21% for non-hematologic toxicity), compared to 46% of patients with score 1 (37% for hematologic and 69% for non-hematologic toxicity), 58% of patients with score 2 (36% for hematologic and 64% for non-hematologic toxicity) and 100% of patients with score 3 or 4 (all patients for both types of toxicity). High adult comorbidity index-27 scores identified patients at high risk of grade 3/4 hematologic toxicity. Forty-one patients (32.8%) experienced pleural effusion during treatment: the highest scores for both indices were associated with an increased risk of pleural effusions.
  
  
  CONCLUSIONS
  In elderly patients with chronic myeloid leukemia treated with dasatinib, the rate of drug reduction or suspension and the incidence of pleural effusions seem to be associated with the presence of comorbidities: stratification according to the Charlson index and adult comorbidity evaluation-27 score before dasatinib therapy may enable the identification of patients at risk of major toxicities.
authors.affiliation: Dipartimento di Biotecnologie Cellulari ed Ematologia, Università La Sapienza, Roma, Italy. breccia@bce.uniroma1.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Breccia
authors.forename: Roberto
authors.initials: R
authors.lastname: Latagliata
authors.forename: Fabio
authors.initials: F
authors.lastname: Stagno
authors.forename: Luigiana
authors.initials: L
authors.lastname: Luciano
authors.forename: Antonella
authors.initials: A
authors.lastname: Gozzini
authors.forename: Fausto
authors.initials: F
authors.lastname: Castagnetti
authors.forename: Carmen
authors.initials: C
authors.lastname: Fava
authors.forename: Francesco
authors.initials: F
authors.lastname: Cavazzini
authors.forename: Mario
authors.initials: M
authors.lastname: Annunziata
authors.forename: Antonella
authors.initials: A
authors.lastname: Russo Rossi
authors.forename: Patrizia
authors.initials: P
authors.lastname: Pregno
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Abruzzese
authors.forename: Paolo
authors.initials: P
authors.lastname: Vigneri
authors.forename: Giovanna
authors.initials: G
authors.lastname: Rege-Cambrin
authors.forename: Simona
authors.initials: S
authors.lastname: Sica
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Pane
authors.forename: Valeria
authors.initials: V
authors.lastname: Santini
authors.forename: Giorgina
authors.initials: G
authors.lastname: Specchia
authors.forename: Gianantonio
authors.initials: G
authors.lastname: Rosti
authors.forename: Giuliana
authors.initials: G
authors.lastname: Alimena
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000069439:Dasatinib; D005260:Female; D006801:Humans; D015994:Incidence; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D055118:Medication Adherence; D010996:Pleural Effusion / Q000150:complications* / Q000453:epidemiology; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011743:Pyrimidines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D013844:Thiazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D011743:Pyrimidines; D013844:Thiazoles; D000069439:Dasatinib