Hemoglobin changes during long-lasting frontline treatment with Tyrosine-Kinase inhibitors in patients with chronic myeloid leukemia

To assess the impact of imatinib compared to 2 G-TKIs on hemoglobin (Hb) in the long-lasting frontline treatment, 242 patients with chronic myeloid leukemia (CML) from 2 Centers still receiving frontline TKI after 5 years [186 (76.8%) imatinib and 56 (23.2%) 2 G-TKIs] were evaluated. Baseline rate of patients with mild/moderate anemia (Hb < 11 g/dl) was lower in those treated with imatinib (18.2% vs 35.7% with 2 G-TKIs, p = 0.006), while at the 60th month became significantly higher in those treated with imatinib (15.6% vs 3.6% with 2 G-TKI, p = 0.018). Event-free and Overall Survival beyond the 60th month in patients receiving imatinib with anemia at that time-point were significantly shorter than in patients without anemia (p < 0.001 and p = 0.002, respectively). Long-lasting treatment with imatinib caused late anemia in about 15% of patients at the 60th month. This event, which seems very rare with 2 G-TKIs, affected survival and should be recognized in the long-term management of CML patients.