title: Differences among young adults, adults and elderly chronic myeloid leukemia patients.
abstract: BACKGROUND
  The incidence of chronic myeloid leukemia (CML) increases with age, but it is unclear how the characteristics of the disease vary with age. In children, where CML is very rare, it presents with more aggressive features, including huge splenomegaly, higher cell count and higher blast cell percentage.
  
  
  METHODS
  To investigate if after childhood the disease maintains or loses these characteristics of aggressiveness, we analyzed 2784 adult patients, at least 18 years old, registered by GIMEMA CML WP over a 40-year period.
  
  
  RESULTS
  Young adults (YAs: 18-29 years old) significantly differed from adults (30-59 years old) and elderly patients (at least 60 years old) particularly for the frequency of splenomegaly (71%, 63% and 55%, P < 0.001), and the greater spleen size (median value: 4.5, 3.0 and 1.0 cm, P < 0.001). According to the EUTOS score, that is age-independent, high-risk patients were more frequent among YAs, than among adult and elderly patients (18%, 9% and 6%, P < 0.001). In tyrosine kinase inhibitors-treated patients, the rates of complete cytogenetic and major molecular response were lower in YAs, and the probability of transformation was higher (16%, 5% and 7%, P = 0.011).
  
  
  CONCLUSIONS
  The characteristics of CML or the host response to leukemia differ with age. The knowledge of these differences and of their causes may help to refine the treatment and to improve the outcome.
  
  
  BACKGROUND
  NCT00510926, NCT00514488, NCT00769327, NCT00481052.
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L. and A. Seràgnoli', 'S. Orsola-Malpighi' University Hospital. Electronic address: fausto.castagnetti@unibo.it.
authors.forename: F
authors.initials: F
authors.lastname: Castagnetti
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L. and A. Seràgnoli', 'S. Orsola-Malpighi' University Hospital.
authors.forename: G
authors.initials: G
authors.lastname: Gugliotta
authors.affiliation: Department of Hematology and Oncology 'L. and A. Seràgnoli', University of Bologna, Bologna.
authors.forename: M
authors.initials: M
authors.lastname: Baccarani
authors.affiliation: Hematology Section, Department of Biotechnologies and Cellular Hematology, 'La Sapienza' University, Rome.
authors.forename: M
authors.initials: M
authors.lastname: Breccia
authors.affiliation: Chair of Hematology, University of Bari, Bari.
authors.forename: G
authors.initials: G
authors.lastname: Specchia
authors.affiliation: Hematology Unit, 'Pugliese-Ciaccio' Hospital, Catanzaro.
authors.forename: L
authors.initials: L
authors.lastname: Levato
authors.affiliation: Hematology Unit, 'S. Eugenio' Hospital, Rome.
authors.forename: E
authors.initials: E
authors.lastname: Abruzzese
authors.affiliation: Hematology Unit, Azienda Ospedaliera 'Spedali Civili', Brescia.
authors.forename: G
authors.initials: G
authors.lastname: Rossi
authors.affiliation: Oncohematology of the Elderly Unit, Division of Oncohematology, IRCCS Ca' Granda-Maggiore University Hospital, Milan.
authors.forename: A
authors.initials: A
authors.lastname: Iurlo
authors.affiliation: Hematology Unit, Azienda Ospedaliera 'Bianchi-Melacrino-Morelli', Reggio Calabria.
authors.forename: B
authors.initials: B
authors.lastname: Martino
authors.affiliation: Hematology Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Turin.
authors.forename: P
authors.initials: P
authors.lastname: Pregno
authors.affiliation: Hematology Section, Department of Biomedical Sciences, University of Catania, Catania.
authors.forename: F
authors.initials: F
authors.lastname: Stagno
authors.affiliation: Chair of Hematology, Azienda Ospedaliero-Universitaria Arcispedale S. Anna, University of Ferrara, Ferrara.
authors.forename: A
authors.initials: A
authors.lastname: Cuneo
authors.affiliation: Hematology Section, Department of Medicine, University of Verona, Verona.
authors.forename: M
authors.initials: M
authors.lastname: Bonifacio
authors.affiliation: Clinical Hematology Unit, IRCCS AOU San Martino-IST, Genoa.
authors.forename: M
authors.initials: M
authors.lastname: Gobbi
authors.affiliation: Blood Diseases and Stem Cell Transplantation Unit, Azienda Ospedaliera 'Spedali Civili', University of Brescia, Brescia.
authors.forename: D
authors.initials: D
authors.lastname: Russo
authors.affiliation: Hematology Unit, 'Careggi' University Hospital, Florence.
authors.forename: A
authors.initials: A
authors.lastname: Gozzini
authors.affiliation: Hematology Unit, 'S. Maria Della Misericordia' University Hospital, Udine.
authors.forename: M
authors.initials: M
authors.lastname: Tiribelli
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L. and A. Seràgnoli', 'S. Orsola-Malpighi' University Hospital.
authors.forename: A
authors.initials: A
authors.lastname: de Vivo
authors.affiliation: Hematology Section, Department of Biotechnologies and Cellular Hematology, 'La Sapienza' University, Rome.
authors.forename: G
authors.initials: G
authors.lastname: Alimena
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L. and A. Seràgnoli', 'S. Orsola-Malpighi' University Hospital.
authors.forename: M
authors.initials: M
authors.lastname: Cavo
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L. and A. Seràgnoli', 'S. Orsola-Malpighi' University Hospital.
authors.forename: G
authors.initials: G
authors.lastname: Martinelli
authors.affiliation: Hematology Section, Department of Biochemistry and Medical Biotechnologies, 'Federico II' University, Naples.
authors.forename: F
authors.initials: F
authors.lastname: Pane
authors.affiliation: Department of Clinical and Biological Sciences, 'S. Luigi Gonzaga' University Hospital, University of Torino, Orbassano, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Saglio
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L. and A. Seràgnoli', 'S. Orsola-Malpighi' University Hospital.
authors.forename: G
authors.initials: G
authors.lastname: Rosti
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors; D013154:Spleen / Q000473:pathology; D013163:Splenomegaly / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D011505:Protein-Tyrosine Kinases
keywords: BCR-ABL; chronic myeloid leukemia; prognosis; tyrosine kinase inhibitors; young adults