[Variables associated with severe cytopenia in adult chronic phase chronic myeloid leukemia patients receiving initial tyrosine kinase inhibitors].
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Objective: To explore the variables associated with severe cytopenia in patients with chronic phase chronic myeloid leukemia (CML-CP) receiving initial tyrosine kinase inhibitor (TKI) therapy. Methods: Data from consecutive patients aged ≥18 years with CML-CP who received imatinib, nilotinib, or flumatinib at Peking University People's Hospital between November 2006 and January 2025 were retrospectively reviewed. Binary logistic regression models were applied to analyze the variables associated with severe cytopenia (according to Common Terminology Criteria for Adverse Events version 5.0, with a focus on grade 3/4 leukocytopenia or thrombocytopenia) . Results: This study included 1 906 patients initially receiving imatinib (n=1 542, 80.9%), nilotinib (n=256, 13.4%), and flumatinib (n=108, 5.7%). The median age was 41 (range, 18-83) years, and 1 141 (59.9%) patients were male. At a median of 1 (range, 0.2-3) month, 186 (9.8%) patients developed grade 3/4 cytopenia, primarily thrombocytopenia, and persisted for 0.6 (range, 0.1-10.6) months, including 68 (3.6%) patients who developed grade 4 cytopenia. No significant difference in the incidence of grade 3/4 cytopenia was observed among patients receiving the three TKIs, whereas grade 4 cytopenia was more common in those receiving the second-generation (2G) TKI (nilotinib and flumatinib) compared with imatinib (7.3% vs 2.7%, P=0.001). Multivariate analysis revealed that female sex, decreased hemoglobin level, and increased white blood cell count (or splenomegaly) were significantly associated with the higher incidence of severe cytopenia in patients receiving TKI. Based on the adverse variables, patients receiving imatinib were categorized into low- and high-risk groups, and those receiving 2G-TKI were classified into low-, medium-, and high-risk groups with a significant difference in the incidence of grades 3/4 and 4 cytopenia (P<0.001) . Conclusion: Severe cytopenia is a common adverse event in patients with CML-CP receiving TKI therapy. Grade 4 cytopenia is more common in those receiving 2G-TKI compared with imatinib. High-risk factors for severe cytopenia associated with TKIs included female sex, decreased hemoglobin level, increased white blood cell count, and splenomegaly at initial diagnosis. Close monitoring is necessary during the early phase of TKI-therapy for the high-risk group.