Health status impairments in tyrosine kinase inhibitor-treated chronic myeloid leukemia patients versus blood or marrow transplant survivors and non-cancer controls

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Tyrosine kinase inhibitor (TKI) therapy has resulted in a significant reduction in chronic myeloid leukemia (CML)-related mortality. However, the impact of TKIs on the health status of long-term CML survivors remains unstudied. We examined the health status of 62 TKI-treated CML patients who did not receive blood or marrow transplantation (BMT) (CML_TKI; median follow-up: 12.5 y) compared with an unaffected population (303 non-CML controls), and CML patients treated with BMT but without TKI exposure (220 CML_BMT; median follow-up 19.4 y). Participants self-reported general health, functional status, activity limitations, and pre-frailty/frailty. Overall, 71.0% of CML_TKI participants had ≥1 adversely-affected domain vs. 42.6% of non-CML and 65.9% of CML_BMT participants. When compared with the non-CML controls, the CML_TKI cohort was more like to have poor general health (aOR = 4.43, 95%CI = 1.8-10.7), functional impairment (aOR=2.84, 95%CI = 1.4-6.0), and activity limitation (aOR=3.37, 95%CI = 1.7-6.7) and more likely to be frail/pre-frail (aOR=3.71, 95%CI = 1.7-8.1). The CML_TKI and CML_BMT cohorts were comparable with respect to poor general health (aOR = 0.95, 95%CI = 0.5-2.0), functional impairment (aOR = 1.59, 95%CI = 0.8-3.0), and pre-frailty/frailty (aOR = 1.92, 95%CI = 0.92-4.0), but the CML_TKI cohort was more likely to report activity limitation (aOR = 2.2, 95%CI = 1.1-4.5). These findings inform a need for long-term monitoring and development of risk mitigation strategies to improve the health status as a treatment goal in CML care.