| Description |
Chronic myeloid leukemia (CML) is a clonal myeloproliferative disorder characterized by the presence of a chromosomal abnormality, known as Philadelpia chromosome, which results in the formation of the BCR-ABL1 fusion gene. The Bcr-Abl protein is an oncogenic tyrosine kinase with constitutive activity responsible for all CML features. Natural course and particularly prognosis of the patients with CML improved fundamentally during last fourteen years thanks to tyrosine kinase inhibitor (TKI) targeted therapy introduction. Median age of the patients with newly diagnosed CML ranges between 60 and 65 years according to most epidemiologic registries. Prior to the TKI era, older age was considered an adverse prognostic factor and was included in two most used scoring systems for CML, the Sokal score and the Hasford score. Moreover, older age was considered a limitation for the use of the only curative treatment, allogeneic stem cells transplantation. After the introduction of TKIs, age lost much of its prognostic significance and the new scoring system, the EUTOS score, developed on imatinib treated patients, did not identify age as a risk variable. Clinical trials comparing younger and elderly patients treated with imatinib after interferon-alfa failure either in the first line setting in newly diagnosed patients showed no difference in overall outcome. Few available data about second generation TKIs, dasatinib and nilotinib, in the treatment of elderly patients confirmed their efficacy and limited toxicity profile as in younger patients. Nowadays, elderly patients should be treated according the same treatment recommendation as younger patients, with focus on treatment efficacy monitoring and appropriate therapy switch in case of failure or intolerance. Particular TKI choice and final decision about therapeutic strategy in each patient should be guided by different toxicity profile and cost of available TKIs, by patient specific comorbidities, by overall performance, physical and mental status of each particular patient, and by his/her treatment adherence estimation. The presented book chapter represents a comprehensive and up-to-date review of chronic myeloid leukemia in elderly patients regarding its definition, epidemiology, clinical presentation, diagnostic tests and procedures, differential diagnostics, treatment and monitoring recommendations and proceedings, and prognosis. Current approach to the elderly patients with CML is documented by a case report from every-day clinical practice in the center of specialized hematological care.
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