Management of elderly patients with chronic myeloproliferative hemopathies

Abstract

Background: Chronic myeloproliferative hemopathies (CMPH) as a whole are the most common chronic leukemias in the elderly in the structure of morbidity by hematological malignancies with primary bone marrow involvement, being characterized in the advanced stages by a severe, recurrent evolution and unfavorable prognosis, with negative socio-economic impact. Material and methods: A clinical, analytical, and descriptive study was carried out along with the narrative review of the international literature on the subject. The study enrolled 91 elderly patients with different phases of chronic myeloid leukemia (CML), primary myelofibrosis (PMF) and polycythemia vera (PV), who were followed up and treated at the Institute of Oncology in the period of 1995–2020. According to the impact score, 25 relevant primary sources were identified and selected having a scientific, reproducible and transparent approach to the relevant subject, followed by data extraction and analysis. Results: The overall one- and 5-year survival in patients aged greater than or equal to 60 years old treated with tyrosine kinase inhibitors (TKIs) was 97.6 and 79%, being lower as compared with the same indices in the totality of CML. In elderly PV patients the overall 5-and 10-year survival made up 93.5% and 76.4%, being lesser than registered in all patients with PV. As reported in the recent references, a significant rate of patients with CMPH underwent reduced working hours, discontinued employment, and medical disability: PMF – 38%, 35%, 33%, and PV – 33%, 28%, and 15%, respectively. Conclusions: The long-term treatment results in elderly patients with CMPH fail compared to those in the CMPH totality, due to the development of age-related diseases and vascular accidents caused by leuko- and thrombocytosis.