GIMEMA SURVEY ON THE MANAGEMENT OF CHRONIC MYELOID LEUKEMIA PATIENTS IN THIRD LINE AND BEYOND: INSIGHTS FROM ITALIAN HEMATOLOGISTS

MASSIMO BRECCIA^1*Alfonso Piciocchi²Elisabetta Abruzzese³Daniela Cilloni⁴Fausto Castagnetti⁵Monica Messina⁶Stefano Soddu⁶Barbara Scappini⁷Uros Markovic⁸Mario Annunziata⁹Alessandra Malato¹⁰Gianni Binotto¹¹Olga Mulas¹²Massimiliano Bonifacio¹³Paola Fazi⁶Fabrizio Pane¹⁴

• ¹Sapienza University of Rome, Rome, Italy
• ²Fondazione GIMEMA Onlus Centro Dati, Rome, Italy
• ³Ospedale Sant'Eugenio, Rome, Italy
• ⁴Universita degli Studi di Torino, Turin, Italy
• ⁵Universita degli Studi di Bologna, Bologna, Italy
• ⁶Fondazione GIMEMA, Rome, Italy
• ⁷Azienda Ospedaliero Universitaria Careggi, Florence, Italy
• ⁸Universita degli Studi di Catania, Catania, Italy
• ⁹Azienda Ospedaliera di Rilievo Nazionale Antonio Cardarelli, Naples, Italy
• ¹⁰Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, Palermo, Italy
• ¹¹Universita degli Studi di Padova, Padua, Italy
• ¹²Universita degli Studi di Cagliari, Cagliari, Italy
• ¹³Universita degli Studi di Verona, Verona, Italy
• ¹⁴Universita degli Studi di Napoli Federico II, Naples, Italy

Background. About one third of chronic myeloid leukemia (CML) patients may developed resistance and/or intolerance to the current therapies and need to switch to following lines of treatment. How to choose a later line of therapy is still a matter of discussion. Methods. A survey was performed by the Gruppo Italiano Malattie Ematologiche dell'Adulto (GIMEMA) to understand how the scenario has changed after the introduction of the first allosteric inhibitor, asciminib, in later lines. Results. The GIMEMA survey has the aim to reassess the Italian approach to third-line or later-line treatment in CML. In a whole cohort of 1637 patients, for resistance, ponatinib is used with a mean of 41% (SD=29) and a median of 50% (0-100), while asciminib is used with a mean of 27% (SD=23) and a median of 25% (0-100). Indeed, for intolerance, asciminib is the most used with a mean of 32% (SD=30) and a median of 30 (0-100), followed by bosutinib with a mean of 25% (SD=25) and a median of 20 (0-90). Several possible treatment sequences were analysed and asciminib emerges as the best approach in third line. Conclusions. The survey tries to understand the major reasons for treatment switch, how tyrosine kinase inhibitors (TKIs) were selected, and which drug is preferred based on patient and disease characteristics. The current algorithm of treatment seems changed both in resistant and intolerant CML patients in later lines. The reduction of TKI dose is a current practice to maintain efficacy while reducing the occurrence of side effects.