title: Imatinib and polypharmacy in very old patients with chronic myeloid leukemia: effects on response rate, toxicity and outcome.
abstract: BACKGROUND
  About 40% of all patients with chronic myeloid leukemia are currently old or very old. They are effectively treated with imatinib, even though underrepresented in clinical studies. Furthermore, as it happens in the general population, they often receive multiple drugs for associated chronic illnesses. Aim of this study was to assess whether or not in imatinib-treated patients aged >75 years the exposure to polypharmacy (5 drugs or more) had an impact on cytogenetic and molecular response rates, event-free and overall survival, as well as on hematological or extra-hematological toxicity.
  
  
  METHODS
  296 patients at 35 Italian hematological institutions were evaluated.
  
  
  RESULTS
  Polypharmacy was reported in 107 patients (36.1%), and drugs more frequently used were antiplatelets, diuretics, proton pump inhibitors, ACE-inhibitors, beta-blockers, calcium channel blockers, angiotensin II receptors blockers, statins, oral hypoglycemic drugs and alpha blockers. Complete cytogenetic response was obtained in 174 patients (58.8%), 78 (26.4%) within 6 month, 63 (21.3%) between 7 and 12 months. Major molecular response was obtained in 153 patients (51.7%), 64 (21.6%) within the 12 month. One hundred and twenty-eight cases (43.2%) of hematological toxicity were recorded, together with 167 cases (56.4%) of extra-hematological toxicity. Comparing patients exposed to polypharmacy to those without, no difference was observed pertaining to the dosage of imatinib, cytogenetic and molecular responses and hematological and extra-hematological toxicity.
  
  
  CONCLUSIONS
  Notwithstanding the several interactions reported in the literature between imatinib and some of the medications considered herewith, this fact does not seem to have a clinical impact on response rate and outcome.
authors: Oncohematology Division, IRCCS Ca' Granda - Maggiore Policlinico Hospital Foundation, University of Milan, Milan, Italy.
authors: Alessandra
authors: A
authors: Iurlo
authors: Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors: Alessandro
authors: A
authors: Nobili
authors: Department of Cellular Biotechnologies and Hematology, University "La Sapienza" of Rome, Rome, Italy.
authors: Roberto
authors: R
authors: Latagliata
authors: Oncohematology Division, IRCCS Ca' Granda - Maggiore Policlinico Hospital Foundation, University of Milan, Milan, Italy.
authors: Cristina
authors: C
authors: Bucelli
authors: Institute of Hematology "L. and A. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine, "S. Orsola-Malpighi" University Hospital, University of Bologna, Bologna, Italy.
authors: Fausto
authors: F
authors: Castagnetti
authors: Department of Cellular Biotechnologies and Hematology, University "La Sapienza" of Rome, Rome, Italy.
authors: Massimo
authors: M
authors: Breccia
authors: Hematology Unit, Sant'Eugenio Hospital, Rome, Italy.
authors: Elisabetta
authors: E
authors: Abruzzese
authors: Oncohematology Division, IRCCS Ca' Granda - Maggiore Policlinico Hospital Foundation, University of Milan, Milan, Italy.
authors: Daniele
authors: D
authors: Cattaneo
authors: Division of Hematology and Internal Medicine, University of Turin, "San Luigi Gonzaga" University Hospital, Orbassano, Turin, Italy.
authors: Carmen
authors: C
authors: Fava
authors: Hematology Unit, University of Turin, Turin, Italy.
authors: Dario
authors: D
authors: Ferrero
authors: Haematology, AOU Careggi, University of Firenze, Firenze, Italy.
authors: Antonella
authors: A
authors: Gozzini
authors: Department of Medicine, Section of Hematology, University of Verona, Verona, Italy.
authors: Massimiliano
authors: M
authors: Bonifacio
authors: Division of Hematology and BMT, Azienda Ospedaliero - Universitaria di Udine, Udine, Italy.
authors: Mario
authors: M
authors: Tiribelli
authors: Hematology Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy.
authors: Patrizia
authors: P
authors: Pregno
authors: Hematology Unit, Ferrarotto Hospital, Catania, Italy.
authors: Fabio
authors: F
authors: Stagno
authors: Hematology Unit, Ferrarotto Hospital, Catania, Italy.
authors: Paolo
authors: P
authors: Vigneri
authors: Hematology Unit, Cardarelli Hospital, Naples, Italy.
authors: Mario
authors: M
authors: Annunziata
authors: Hematology Unit, University of Ferrara, Ferrara, Italy.
authors: Francesco
authors: F
authors: Cavazzini
authors: Hematology Unit, University of Padova, Padova, Italy.
authors: Gianni
authors: G
authors: Binotto
authors: Department of Onco-Hematology, IRCCS-CROB, Rionero in Vulture, Italy.
authors: Giovanna
authors: G
authors: Mansueto
authors: Hematology Unit, AOU G. Martino, Messina, Italy.
authors: Sabina
authors: S
authors: Russo
authors: Division of Hematology and Clinical Immunology, Department of Medicine, University of Perugia, Perugia, Italy.
authors: Franca
authors: F
authors: Falzetti
authors: Hematology Unit, Sant'Andrea Hospital, Rome, Italy.
authors: Enrico
authors: E
authors: Montefusco
authors: Institute of Hematology "L. and A. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine, "S. Orsola-Malpighi" University Hospital, University of Bologna, Bologna, Italy.
authors: Gabriele
authors: G
authors: Gugliotta
authors: Onco-Hematology Unit, Università Cattolica Giovanni Paolo II, Campobasso, Italy.
authors: Sergio
authors: S
authors: Storti
authors: Immunohematology and Trasfusional Medicine Division, S. Pietro Fatebenefratelli Hospital, Rome, Italy.
authors: Ada M
authors: AM
authors: D'Addosio
authors: Department of Medicine, Section of Hematology, University of Verona, Verona, Italy.
authors: Luigi
authors: L
authors: Scaffidi
authors: Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors: Laura
authors: L
authors: Cortesi
authors: Hematology Unit, S. Giovanni Hospital, Rome, Italy.
authors: Michele
authors: M
authors: Cedrone
authors: Hematology and Transplants Unit, University of Bari, Bari, Italy.
authors: Antonella Russo
authors: AR
authors: Rossi
authors: Hematology, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy.
authors: Paolo
authors: P
authors: Avanzini
authors: Department of Internal Medicine, Pordenone General Hospital, Pordenone, Italy.
authors: Endri
authors: E
authors: Mauro
authors: Hematology and Stem Cell Transplantation Unit, Regina Elena Institute, Rome, Italy.
authors: Antonio
authors: A
authors: Spadea
authors: Hematology Unit, Belcolle Hospital, Viterbo, Italy.
authors: Francesca
authors: F
authors: Celesti
authors: Hematology Unit, Campobasso Hospital, Campobasso, Italy.
authors: Gianfranco
authors: G
authors: Giglio
authors: Hematology Unit, Pesaro Hospital, Pesaro, Italy.
authors: Alessandro
authors: A
authors: Isidori
authors: Hematology and BMT Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
authors: Monica
authors: M
authors: Crugnola
authors: Hematology Unit, Treviso Hospital, Treviso, Italy.
authors: Elisabetta
authors: E
authors: Calistri
authors: Institute of Hematology, Università Cattolica Sacro Cuore, Rome, Italy.
authors: Federica
authors: F
authors: Sorà
authors: Division of Hematology and Internal Medicine, University of Turin, "San Luigi Gonzaga" University Hospital, Orbassano, Turin, Italy.
authors: Giovanna
authors: G
authors: Rege-Cambrin
authors: Institute of Hematology, Università Cattolica Sacro Cuore, Rome, Italy.
authors: Simona
authors: S
authors: Sica
authors: Hematology Unit, ''Federico II'' Hospital, University of Naples, Naples, Italy.
authors: Luigiana
authors: L
authors: Luciano
authors: Department of Clinical and Experimental Medicine, Section of Hematology - University of Pisa, Pisa, Italy.
authors: Sara
authors: S
authors: Galimberti
authors: Oncology-Hematology Department, Hematology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors: Ester M
authors: EM
authors: Orlandi
authors: Hematology Unit, Azienda Ospedaliera Universitaria Senese and University of Siena, Siena, Italy.
authors: Monica
authors: M
authors: Bocchia
authors: Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors: Mauro
authors: M
authors: Tettamanti
authors: Department of Cellular Biotechnologies and Hematology, University "La Sapienza" of Rome, Rome, Italy.
authors: Giuliana
authors: G
authors: Alimena
authors: Division of Hematology and Internal Medicine, University of Turin, "San Luigi Gonzaga" University Hospital, Orbassano, Turin, Italy.
authors: Giuseppe
authors: G
authors: Saglio
authors: Institute of Hematology "L. and A. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine, "S. Orsola-Malpighi" University Hospital, University of Bologna, Bologna, Italy.
authors: Gianantonio
authors: G
authors: Rosti
authors: Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, IRCCS Ca' Granda - Maggiore Policlinico Hospital Foundation and University of Milan, Milan, Italy.
authors: Pier Mannuccio
authors: PM
authors: Mannucci
authors: Oncohematology Division, IRCCS Ca' Granda - Maggiore Policlinico Hospital Foundation, University of Milan, Milan, Italy.
authors: Agostino
authors: A
authors: Cortelezzi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D015897:Comorbidity; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology; D005260:Female; D006801:Humans; D000068877:Imatinib Mesylate / Q000627:therapeutic use*; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D019338:Polypharmacy; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D000068877:Imatinib Mesylate
keywords: chronic myeloid leukemia; comorbidities; imatinib; old patients; polypharmacy