Safety and Efficacy of CEEP (Cyclophosphamide, Epirubicin, Etoposide, Prednisolone) with or without Rituximab in Elderly Patients (>70) with Diffuse Large B-Cell Lymphoma (DLBL): A Retrospective Single Center Experience

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4957-4957
Author(s):  
Danny Hsu ◽  
Ibrahim Tohidi-Esfahani ◽  
Christina Brown ◽  
Scott Dunkley ◽  
Stephen Robert Larsen ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Haematological Toxicity ◽  
The Other ◽  
Single Center ◽  
Safety And Efficacy ◽  
Single Center Experience ◽  
Comorbidity Index ◽  
Grade 3 ◽  
Relapsed Disease

Abstract Abstract 4957 Background Over 40% of patients with the most common lymphoid malignancy worldwide, DLBL, are over the age of 70. Although R-CHOP is inarguably the mainstay of therapy for DLBL patients, a significant number of elderly patients do not tolerate the regimen due to underlying frailty and/or co-morbidities. Most elderly patients with significant co-morbidities have limited treatment options and are not offered anthracycline-containing chemotherapy due to concerns regarding toxicity. Here we describe our single center experience with CEEP, a lower intensity regimen for elderly patients with newly diagnosed or relapsed DLBL whom are deemed inappropriate for CHOP-based chemotherapy. Method All patients >70 years old (median 78.5, range 71 – 85) with histologically proven DLBL treated with CEEP ± Rituximab (R) at Royal Prince Alfred Hospital from 2000 to 2010 were retrospectively reviewed. Modified CEEP, Cyclophosphamide 300mg/m2 Day 1 (D1) and D15, Epirubicin 50mg/m2 D1 and D15, Etoposide 100mg/m2 D1 and D15, and Prednisolone 50mg D1-D5 (reduced dose from original CEEP protocol) was administered every 2 weeks. Rituximab 375mg/m2 (when approved for use in Australia) was administered every 28 days. As per institutional protocol, all patients received Bactrim prophylaxis for Pneumocystis. Baseline characteristics, Charlson Comorbidity Index, Revised International Prognostic Index (RIPI), the number of CEEP cycles, treatment response and toxicity from treatment were identified and reviewed. Results A total of 22 patients were identified, 10 were male. 15 received CEEP as initial therapy, and 7 for relapsed disease. 23% (n=5) had an ECOG score ≥ 2. 55% (n=12) had RIPI ≥ 3. All patients had a Charlson Comorbidity Index ≥ 2, with 23% (n=5) ≥ 5, which was considered sufficient to preclude conventional CHOP-based chemotherapy. Median cardiac ejection fraction was 62% (range 55 – 85%). 73% (n=16) received Rituximab and 50% (n=11) received primary GCSF prophylaxis. The median number of CEEP ± R cycles was 6 (range 2 – 9 cycles). 5% (n=1) required dose reduction and 9% (n=2) required delays in treatment due to haematological toxicity. Median follow-up was 10.0 months (range 1 – 92.7 months). At completion of therapy, complete responses (CR) were demonstrated in 10 patients (45%), with partial responses (PR) seen in 32% (n=7). 18% (n=4) demonstrated progressive disease (PD) despite therapy. Of the 7 patients with relapsed disease prior to CEEP ± R, CR was seen in 2 cases, both of whom had previous exposure to R-CVP (cyclophosphamide, vincristine, prednisolone) chemotherapy. At most recent follow up, 32% (n=7) have remained in CR with a median follow up period of 28.1 months (range 13 – 92.7 months), 36% (n=8) had disease progression, 9% (n=2) demonstrated stable residual disease, while 23% (n=5) have died. Of the 5 deaths, 3 were attributed to progressive DLBL. The other deaths were a result of complications following further salvage chemotherapy. Grade 3 – 4 haematological toxicity was observed in 72% (n=16) of patients. Febrile neutropenia occurred in 41% (n=9). Overall, 50% (n=11) required at least one re-admission to hospital. Non-haematological grade 3 – 4 toxicity was detected in 2 patients, one of whom suffered unstable angina in the setting of anaemia, the other an acute cerebrovascular event in the setting of new atrial flutter post-chemotherapy. Discussion Although limited by a small sample size, our retrospective single center experience demonstrates that CEEP ± R chemotherapy can be administered to elderly patients with significant co-morbidities. Our cohort was all aged >70, with medical co-morbidities leading to the unsuitability of conventional CHOP-based therapy. Whilst an overall response rate of 77% (CR + PR) was observed, on prolonged follow up, 32% of patients remained in CR. Significant haematological toxicity (72%) and infectious complications (41%) were observed, however no deaths were directly attributed to the chemotherapy. Future prospective studies are required to further evaluate the safety and efficacy of R-CEEP in the elderly. Disclosures: No relevant conflicts of interest to declare.

Activity of front-line window therapy with temozolomide plus irinotecan in patients with primary multifocal Ewing sarcoma: ISG/AIEOP EW-2 protocol.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 10516-10516
Author(s):  
Asaftei Dorin Sebastian ◽  
Nadia Puma ◽  
Anna Paioli ◽  
Marco Petraz ◽  
Carlo Morosi ◽  
...  
Keyword(s):  
Ewing Sarcoma ◽  
Haematological Toxicity ◽  
Treatment Strategies ◽  
Front Line ◽  
Survival Estimate ◽  
Radiological Response ◽  
New Treatment ◽  
Grade 3 ◽  
Relapsed Disease

10516 Background: The prognosis of patients with primary multifocal metastatic Ewing sarcoma (PMES) remains dismal. So far, combination with temozolomide and irinotecan (TEMIRI) was tested in patients with refractory or relapsed disease. This study evaluates the activity and the tolerability of TEMIRI as front-line treatment in PMES. Methods: In the study-period 2012-2018, a front-line window therapy with 2 courses TEMIRI (temozolomide 100 mg/sqm/day + irinotecan 50 mg/sqm/day for 5 days every three weeks) was introduced as amendment to the ISG/AIEOP EW-2 protocol ( EUDRACT#2009-011197-15, Vers. 1.02 ) for patients with PMES. Main objective was to test the activity of TEMIRI evaluated by RECIST 1.1 criteria, with centralized revision of the radiological response. Secondary objectives included assessment of the toxicity profile and clinical benefit of the combination. A two-step study design by Simon was planned. Results: Thirty-four patients were enrolled. Median age at diagnosis was 19 years (range 3-55); males/females ratio was 2.4. Primary axial tumour was present in 24 (70%). After TEMIRI, RECIST response was as follows: partial response -20 (59%), stable disease -11 (32%), progression disease -3 (9%). After TEMIRI, amelioration in ECOG/Lansky score was achieved in 25/34 (73,5%), and reduction or disappearance of pain was observed in 31/34 patients (91%). TEMIRI toxicity was manageable: incidence of grade 3-4 nonhaematological and haematological toxicity was 3% and 3%, respectively (67/68 evaluable courses). At the time of the present analysis, 11 patients are alive; 7 of them are in complete remission and completed their treatment program (5-drug standard chemotherapy). With a median follow-up of 31 months (range 23-75), the 3-year survival estimate is 36,5%±0.09. Conclusions: Upfront TEMIRI x 2 courses showed an encouraging activity, with response rate 59% and deserves further evaluation combined with conventional treatments also in non-metastatic patients. In PMES new treatment strategies are urgently needed. Clinical trial information: NCT02727387.

Feasibility and Efficacy of Administration of Bortezomib-Containing Regimens to Patients Over the Age of 70 Years

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 5035-5035
Author(s):  
Christopher Parrish ◽  
Julian Cromack ◽  
Sylvia Feyler ◽  
John Ashcroft ◽  
Roger G. Owen ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Haematological Toxicity ◽  
Sensory Neuropathy ◽  
The Elderly ◽  
Control Cohort ◽  
Light Chain Disease ◽  
Grade 3 ◽  
Elderly Cohort ◽  
And Control

Abstract Abstract 5035 Rationale: Recent studies demonstrate superiority of bortezomib-containing regimens over standard therapy at improving response rates and durability of responses in patients with multiple myeloma (MM). However, limited data exist for the feasibility of delivering bortezomib-containing regimens to patients with MM over the age of 70 years. We therefore conducted a retrospective review of administration of bortezomib in combination with pulsed Dexamethasone (Bort-Dex) in elderly patients to determine the feasibility and toxicity of delivery. Methods: Patients >70 years with MM who had received at least one prior line of treatment but had not been previously exposed to bortezomib, were assessed for their predicted tolerance to Bort-Dex: bortezomib 1.3mg/m2 IV on days 1, 4, 8 and 11 (standard) on a 21 day-cycle or on days 1, 8, 15 and 22 (modified) on a 35 day cycle, in association with dexamethasone 20mg on the day of and day after bortezomib. Treatment was discontinued at maximal disease response, if refractory disease or if treatment-related toxicity precluded further cycles. A control cohort comprised patients <70 years matched for number of prior lines of therapy treated with Bort-Dex. International Myeloma Working Group response criteria and National Institutes of Health toxicity scores were used for assessments. Results: 19 elderly patients with MM (IgG n=14; IgA n=2; light chain disease n=3) and a median age of 80 yrs (range 74, 90) were compared with 19 MM patients (IgG n=11; IgA n=3; light chain disease n=5) aged <70 yrs with a median age of 61 (range 39–70). Patients had received a median of 1 prior line of therapy (range 1, 4) in both cohorts. International staging system (ISS) scores ranged from 1 to 3 with a median of 2 in both cohorts. At diagnosis, in the elderly and control groups respectively, the median beta-2 microglobulin was 3.2 mg/l (range 1.8, 13) and 3.1 mg/l (range 2, 11.2), the median glomerular filtration rate was 49 mls/min/1.72sq.m (range 12, 69) and 71mls/min/1.72sq.m (range 14, 90), and median bone marrow plasmacytosis by flow cytometry was 13% (range 0.9, 51) and 17.2% (range 2.3, 36). Standard (n=12) and modified (n=7) dosing schedules were used in the elderly cohort, with standard dosing in the control cohort. Elderly patients received a median of 3 cycles (range 1–6) compared with a median of 4 cycles (range 1–6) in the control cohort (p=0.11).Response was not assessable in 4 patients: elderly n=3, control n=1. Response to Bort-Dex in the elderly and control cohorts, respectively: 5 (26%) and 6 (32%) patients achieved a complete response (CR) or stringent CR, 4 (21%) and 2 (11%) a very good partial response, 4 (21%) and 7 (37%) a partial response, 3 (16%) and 1 (5%) a minimal response or stable disease, 0 and 2 (11%) progressive disease. Median follow up was 5.1 months (range 0.6, 33.6) in the elderly and 12.1 months (range 0.7, 46.5) in the control cohorts. At last follow-up 7 (37%) patients in the elderly cohort had relapsed, with median time to progression (TTP) of 11.0 months (range 3.3, 16.8). In the control cohort 11 (58%) patients had relapsed with a TTP of 7.3 months (range 0, 21.3), p=0.26. In the elderly cohort, grade 3–4 haematological toxicity was reported in 2 patients (11%) with grade 3–4 non-haematological toxicity reported in 6 patients (32%): sensory neuropathy n=2, motor neuropathy n=1, fatigue n=2, infection n=2. Intensity of Bort-Dex was reduced in 5 patients, due to treatment-related toxicity. In the control cohort, grade 3–4 haematological toxicity was reported in 4 patients (21%) and grade 3–4 non-haematological toxicity in 5 patients (26%, sensory neuropathy in all cases). 2 elderly patients required hospital admission for treatment-related complications: cellulitis/varicella zoster reactivation (n=1; 23 days of admission) and bacterial sepsis (n=1; 41 days). By comparison, in the control cohort 1 patient required admission (15 days) for treatment of infective colitis. No treatment-related mortality was reported. Conclusions: Reductions in the intensity and frequency of dosing are often required in order to deliver Bort-Dex to elderly patients, though with comparable response rates to younger patient populations. Through drug delivery modifications, Bort-Dex therapy can be delivered with an acceptable adverse event profile, offering a suitable salvage therapy for elderly patients with relapsed MM. Disclosures: Cook: Orthobiotec: Consultancy, Speakers Bureau.

Early Safety and Efficacy Analysis of a Phase II Study of Sequential R-CHOP and Yttrium-90 Ibritumomab Tiuxetan (Zevalin®) for Elderly High Risk Patients with Untreated DLBCL.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 926-926 ◽  
Author(s):  
Paul A. Hamlin ◽  
Craig H. Moskowitz ◽  
Brett C. Wegner ◽  
Carol S. Portlock ◽  
David J. Straus ◽  
...  
Keyword(s):  
High Risk ◽  
Sudden Death ◽  
Elderly Patients ◽  
Hematologic Toxicity ◽  
Ibritumomab Tiuxetan ◽  
Safety And Efficacy ◽  
Grade 5 ◽  
Grade 3 ◽  
Yttrium 90

Abstract Introduction: Elderly patients (pts) with high risk DLBCL represent an increasing demographic, are often underserved in clinical trials, and need improved therapies. By the age-adjusted international prognostic index (aaIPI), pts &gt;60 years (yrs) with high-intermediate (HI) and high risk (H) disease had 5 yr survival (OS) rates of 37%, and 21%, respectively. Rituximab’s addition to CHOP has improved responses and outcomes, but &gt;50% of high risk pts still relapse. We are investigating the safety and efficacy of sequential RCHOP followed by Yttrium-90 ibritumomab tiuxetan (Zevalin ®) radioimmunotherapy (RIT) in an effort to improve these results. An early safety analysis of this sequential program is presented here. Methods: Untreated ASCT-ineligible pts &gt;60 yrs, with aaIPI HI or H risk DLBCL are eligible for study. Induction: pts receive R-CHOP chemotherapy at standard doses q 21 days x 6 cycles with prophylactic pegfilgrastim (or G-CSF) and darbepoetin alfa (Aranesp ®) support. Consolidation: pts with ≥ stable disease at post RCHOP restaging are eligible for 90Y-90 ibritumomab tiuxetan, given 6–9 weeks post RCHOP; For platelet (plt) counts ≥ 150K → 0.4 mCi/kg dose, plt counts of 100–149K → 0.3 mCi/kg. Weekly CBC’s are performed until week 12–13 restaging. Results: 26 pts have been enrolled as of July 12th, 2005. Median age is 75 (range 65–85; male:female 9:17); KPS &lt;80% in 55% (median 70%, range 60–90%); LDH &gt; nl: 89% (range 150–804); Stage III/IV: 11.5% / 88.5 %; Extranodal sites are &gt;1 in 50%; B symptoms in 54%; aaIPI HI (2 factors) = 46%, H (3 factors) = 54%; 18/26 pts have completed RCHOP; 8 pts are off study before RIT for: 4 cardiovascular events (1 CHF,1 Non-Q-wave MI, 1 sudden death, 1 V. Fib arrest), 3 neutropenic sepsis (1=grade 4, 2=grade 5), 1 leptomeningeal progression; 14 pts have received RIT. Median nadir counts during RIT occur at week 6–7: absolute neutrophil count (ANC) = 850 cells/mm3 (0.3–5.4), Hemoglobin (Hgb)= 10.1 gm/dl (6.6–14.6), plt = 28K cells/mm3 (7–103); Grade 3 and 4 ANC = 39%/39%, Hgb 39%/0%, Plt 46%/15%; During RIT, blood and Plt transfusion occurred for 46% and 31%, respectively; colony stimulating factor and erythropoietic support was used in 39% and 31%, respectively. One pt had delayed count recovery post RIT (448 days, transfusion independent from week 12→). Non-hematologic serious adverse events after RIT include: two grade 3 neutropenic infection (1 without fever), 1 grade 5 sudden death at week 7 (autopsy refused). OS and EFS for all pts by intent to treat is 60% and 55%, respectively, with 14 months median followup. Of pts post-RIT &gt;12 weeks (11 pts), none have relapsed with 21 months median follow-up. Conclusions: Treatment of elderly aaIPI HI and H risk DLBCL pts with sequential RCHOP followed by 90Y ibritumomab tiuxetan is feasible and associated with manageable toxicity. Hematologic toxicity with RIT is similar to single agent toxicity, with slightly greater thrombocytopenia that warrants careful follow-up. Toxicity during RCHOP induction is significant in high risk elderly patients and cycle one modification is being implemented. Accrual continues to evaluate the potential long term impact of RIT on EFS and OS.

Rituximab-Bendamustine Cytarabine (R-BAC) As Frontline Therapy in Mantle Cell Lymphoma: A Single-Center Experience

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 2710-2710 ◽  
Author(s):  
Antonio Branca ◽  
Ilaria Gianesello ◽  
Luca Brugnaro ◽  
Tamara Berno ◽  
Silvia Imbergamo ◽  
...  
Keyword(s):  
Mantle Cell Lymphoma ◽  
Induction Therapy ◽  
Cell Lymphoma ◽  
Synergistic Activity ◽  
Single Center ◽  
Rituximab Maintenance ◽  
Single Center Experience ◽  
Mantle Cell ◽  
Grade 3

Abstract Background and objectives. Bendamustine in combination with rituximab has demonstrated a relevant clinical activity and a good toxicity profile in patients with mantle cell lymphoma (MCL). Cytosine arabinoside (Ara-C) is a key drug in induction chemotherapy regimens of young patients with MCL. In vitro studies have shown that bendamustine increases the cytotoxic effect of Ara‐C in leukemic blasts and lymphoma cells, and the two drugs display high synergistic activity when used in consecutive combinations. Clinically, it has recently been demonstrated that rituximab + bendamustine + Ara‐C (R-BAC) combination has a remarkable activity and is well tolerated both in untreated and in relapsed/refractory patients with MCL (Visco C et al. J Clin Oncol 2013 31:1442-1449). In the present study, we report data from an Italian single-center experience evaluating the efficacy and tolerability of R-BAC association in previously untreated MCL patients both eligible and ineligible for transplantation. Design and methods. From January 2009 to November 2014, 25 newly diagnosed patients with MCL (median 67 years; range 57-83 years) were treated with immunochemotherapy according to R-BAC schedule (Rituximab 375 mg/mq day 1; Bendamustine 70 mg/mq days 2, 3; Ara-C 500 mg/mq days 2-4) x 4 or 6 28-day cycles. All patients received G-CSF prophylaxis. Ninety-six percent of patients had stage III/IV disease; MIPI score was high in 24%, intermediate in 60% and low in 12%; in one patient it was not evaluable. Results. Twenty-two patients (88%) completed the scheduled treatment (4 or 6 cycles). The ORR was 88%: CR 84% (21 patients); PR 4% (1 patient); 1 patient was in SD, but he received only 1 cycle due to toxicity and died still in SD about three years later. Seven patients (28%) underwent autologous stem cell transplantation (ASCT); seven patients (28%) received rituximab maintenance for two years. Two patients (8%) experienced disease progression during first line therapy, both had intermediate MIPI score. After a median follow up of 33 months (range 4-65 months), the OS was 80% (one patient died for unrelated causes) and the PFS was 80%. At this time point, 19 (76%) and 1 (4%) patient were in CR and in PD, respectively. The latter patient is currently undergoing salvage chemotherapy. Patients who received either maintenance immunotherapy with rituximab or consolidation with ASCT after R-BAC (overall 56%) seemed to experience longer PFS and OS. In the ASCT group the OS was 100% at a median follow up of 23 months; in the rituximab maintenance group the OS was 71% at a median follow up of 41 months. In the group of patients that received R-BAC induction therapy only, the OS was 61% at a median follow up of 26 months (p=0.14, likely due to the low number). The most common adverse events (AEs) during R-BAC were hematological: grade 3-4 neutropenia (88%), grade 3-4 thrombocytopenia (64%) and grade 3-4 anemia (36%). The numbers of common grade 3/4 non hematological AEs in the study included: febrile neutropenia (28%), acute coronary syndrome (4%), lung infection (4%) and hyperglycemia (4%). No treatment-related mortality was observed, one patient died of secondary acute myeloid leukemia four years later from induction therapy. Conclusions. The present retrospective study confirms that R-BAC as frontline regimen in MCL is well tolerated and highly effective in ASCT ineligible patients and that it can be administered also in ASCT eligible patients as induction therapy. Moreover, our data suggest that a consolidation therapy (ASCT or maintenance immunotherapy) after R-BAC induction could improve the outcome. Disclosures No relevant conflicts of interest to declare.

scholarly journals In Elderly Patients with CML Second Generation TKIs Are Very Effective and Can be Given Long Term Particularly in the Absence of Comorbidities: A Single Center Experience

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5455-5455
Author(s):  
Mariella D'Adda ◽  
Elisa Cerqui ◽  
Samantha Ferrari ◽  
Chiara Bottelli ◽  
Angela Passi ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Hematologic Toxicity ◽  
Single Center ◽  
Single Center Experience ◽  
Line Therapy ◽  
Grade 3 ◽  
Sokal Score ◽  
Tki Treatment

Abstract INTRODUCTION: Second and third generation tyrosine kinase inhibitors (TKIs) are available for Philadelphia positive chronic myeloid leukemia (Ph+ CML) treatment, but though median age at diagnosis is 60-65 years, elderly patients are under-represented in clinical trials concerning 2G-TKIs and a very small number of papers has been published with series of CML patients > 65 years treated with 2G-TKIs or ponatinib. AIM: we have reviewed our single-center experience with 2G-TKIs in chronic-phase CML (CP-CML) patients > 65 years, in first or subsequent therapeutic lines. PATIENTS AND METHODS: the patients were 10 females and 13 males; CML diagnosis had been made between 1994 and 2015 at a median age of 67 years (61-77). According to Sokal score, 3 patients (13%) were classified as low, 15 (65%) as intermediate and 5 (22%) as high-risk respectively. B3a2 transcript was detected in 13 (56%), b2a2 in 10 (44%) cases. Overall, 30 therapies with 2G-TKIs were prescribed in 23 patients CP-CML > 65 years old, from 2007 to 2015. At 2G-TKI therapy start the median age was 68 years (65-79). Charlson Comorbidity Index (CCI) score was 0 in 11 patients, 1 in 4 patients, 2 in 4 patients, 3 in 3 patients and 4 in 1 patient. Thirteen of 23 patients received second-generation TKIs (2G-TKIs) up-front (6 nilotinib, 7 dasatinib), 10/23 patients as 2nd line therapy (6 nilotinib, 4 dasatinib) after imatinib failure (8/10) or intolerance (2/10), median time from imatinib start to 2G-TKIs being 18 months (9-120). Five of 23 patients needed a TKI as 3rd therapeutic line (4 dasatinib, 1 bosutinib), 1 patient also as 4th (ponatinib) and 5th line (bosutinib). RESULTS: all 23 patients are alive after a median follow up of 45 months (12-259) from diagnosis; median follow up from the first 2G-TKI treatment is 36 months (12-110), in details 37 months (12-110) for patients that received 2G-TKIs up front and 34 months (12-70) for patients that received first 2G-TKI as second line therapy. Seventeen of 23 patients (74%) are still on 2G-TKI therapy, with a median treatment of 37 months (12-110) -table 1-. At the last visit 15/17 patients had MMR or best results (1 MR4.5, 9 MR4, 4 MR3). Six patients of 23 (26 %) stopped definitively 2G-TKI therapy, after a median treatment duration of 31 months (6-68) from the first 2G-TKI (table 2), in all cases for non-hematologic toxicity: 1 recurrent pleural effusion (grade 2), 1 geriatric syndrome, 1 carotid atherosclerotic disease, 1 PAOD, 1 vomiting (grade 3) and 1 pulmonary hypertension. At discontinuation, the disease response was MMR (2 patients), MR4 (3 patients), MR 4.5 (1 patient). Hematologic toxicity occurred during 2G-TKI treatment in 7/23 patients (30%), grade 1-2 in 4, grade 3-4 in 3. Sixteen of 23 (69%) patients experienced non-hematologic toxicity, grade 1-2 in 7 (30%) -5/7 pleural effusion-, and grade 3-4 in 9 (39%) -table 3-. There were no significant differences between patients still on therapy and patients that completely discontinued 2G-TKIs regarding Sokal score risk and b2a2/b3a2 transcripts. Conversely, CCI differed in these 2 categories, because CCI was > 1 in 5/6 (83%) of "discontinued" patients and in 7/17 (41%) of "ongoing" patients. Among the eleven patients with CCI = 0, only 1 discontinued 2G-TKI treatment. CONCLUSIONS: Our experience shows that 2G-TKIs are very effective in elderly CP-CML, not only as first line therapy. Non-hematologic toxicity is high and it is the main reason for 2G-TKI discontinuation, that appears to be related to comorbidities. The vast majority of patients without comorbidities remain on 2G-TKI treatment long term. Disclosures No relevant conflicts of interest to declare.

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