{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T23:41:25Z","timestamp":1790379685488,"version":"4.1.0"},"reference-count":40,"publisher":"American Society of Hematology","issue":"1","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,12,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Patients with chronic myeloid leukemia (CML) often have comorbidities, at an incidence that might be higher than in the general population. Because of the favorable outcome of most patients with CML treated with tyrosine kinase inhibitors (TKIs), a greater number of comorbidities might be the most significant adverse feature for long-term survival. The presence of comorbidities may also affect the risk of developing adverse events with TKIs. This effect is perhaps best exemplified by the risk of developing arterio-occlusive events, which is greatest for patients who have other risk factors for such events, with the risk increasing with higher numbers of comorbidities. The coexistence of comorbidities in patients with CML not only may affect TKI selection but also demands close monitoring of the overall health condition of the patient to optimize safety and provide the opportunity for an optimal outcome to such patients. With optimal, holistic management of leukemia and all other conditions afflicting them, patients with CML and comorbidities may aim for a near-normal life expectancy, just as the more select patients enrolled in clinical trials now enjoy.<\/jats:p>","DOI":"10.1182\/hematology.2020006911","type":"journal-article","created":{"date-parts":[[2020,12,5]],"date-time":"2020-12-05T04:50:21Z","timestamp":1607143821000},"page":"237-242","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":20,"title":["How to manage CML patients with comorbidities"],"prefix":"10.1182","volume":"2020","author":[{"given":"Jorge","family":"Cortes","sequence":"first","affiliation":[{"name":"Georgia Cancer Center, Augusta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"234","reference":[{"issue":"24","key":"2020121621272787000_B1","doi-asserted-by":"crossref","first-page":"2260","DOI":"10.1056\/NEJMoa1002315","article-title":"Dasatinib versus imatinib in newly diagnosed chronic-phase chronic myeloid leukemia","volume":"362","author":"Kantarjian","year":"2010","journal-title":"N Engl J Med"},{"issue":"24","key":"2020121621272787000_B2","doi-asserted-by":"crossref","first-page":"2251","DOI":"10.1056\/NEJMoa0912614","article-title":"Nilotinib versus imatinib for newly diagnosed chronic myeloid leukemia","volume":"362","author":"Saglio","year":"2010","journal-title":"N Engl J Med"},{"issue":"10","key":"2020121621272787000_B3","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1016\/j.clml.2017.06.011","article-title":"Elevated cardiovascular disease risk in patients With chronic myelogenous leukemia seen in community-based oncology practices in the United States","volume":"17","author":"Coutinho","year":"2017","journal-title":"Clin Lymphoma Myeloma Leuk"},{"issue":"7","key":"2020121621272787000_B4","doi-asserted-by":"crossref","first-page":"e283","DOI":"10.1016\/j.clml.2018.05.001","article-title":"Comorbidity burden and use of concomitant medications at CML diagnosis: a retrospective analysis of 527 patients from the Polish Adult Leukemia Group Registry [published correction appears in Clin Lymphoma Myeloma Leuk. 2018;18(10):692]","volume":"18","author":"Gora-Tybor","year":"2018","journal-title":"Clin Lymphoma Myeloma Leuk"},{"issue":"12","key":"2020121621272787000_B5","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1016\/j.clml.2015.09.008","article-title":"Use of real-world claim databases to assess prevalence of comorbid conditions relevant to the treatment of chronic myelogenous leukemia based on National Comprehensive Network Treatment Guidelines","volume":"15","author":"Jabbour","year":"2015","journal-title":"Clin Lymphoma Myeloma Leuk"},{"issue":"10","key":"2020121621272787000_B6","doi-asserted-by":"crossref","first-page":"2329","DOI":"10.1007\/s00277-019-03767-y","article-title":"Outcome of very elderly chronic myeloid leukaemia patients treated with imatinib frontline","volume":"98","author":"Crugnola","year":"2019","journal-title":"Ann Hematol"},{"issue":"6","key":"2020121621272787000_B7","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1182\/bloodadvances.2018025874","article-title":"Analysis of cardiovascular and arteriothrombotic adverse events in chronic-phase CML patients after frontline TKIs","volume":"3","author":"Jain","year":"2019","journal-title":"Blood Adv"},{"issue":"1","key":"2020121621272787000_B8","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1182\/blood-2015-01-617993","article-title":"Impact of comorbidities on overall survival in patients with chronic myeloid leukemia: results of the randomized CML study IV","volume":"126","author":"Saussele","year":"2015","journal-title":"Blood"},{"issue":"20","key":"2020121621272787000_B9","doi-asserted-by":"crossref","first-page":"2333","DOI":"10.1200\/JCO.2015.64.8899","article-title":"Final 5-year study results of DASISION: the Dasatinib Versus Imatinib Study in Treatment-Na\u00efve Chronic Myeloid Leukemia Patients Trial","volume":"34","author":"Cortes","year":"2016","journal-title":"J Clin Oncol"},{"issue":"5","key":"2020121621272787000_B10","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1038\/leu.2016.5","article-title":"Long-term benefits and risks of frontline nilotinib vs imatinib for chronic myeloid leukemia in chronic phase: 5-year update of the randomized ENESTnd trial","volume":"30","author":"Hochhaus","year":"2016","journal-title":"Leukemia"},{"issue":"5","key":"2020121621272787000_B11","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1001\/jamaoncol.2015.5932","article-title":"Association between BCR-ABL tyrosine kinase inhibitors for chronic myeloid leukemia and cardiovascular events, major molecular response, and overall survival: a systematic review and meta-analysis","volume":"2","author":"Douxfils","year":"2016","journal-title":"JAMA Oncol"},{"issue":"3","key":"2020121621272787000_B12","doi-asserted-by":"crossref","first-page":"161","DOI":"10.7326\/M15-2306","article-title":"Cardiovascular events associated with use of tyrosine kinase inhibitors in chronic myeloid leukemia: a population-based cohort study","volume":"165","author":"Dahl\u00e9n","year":"2016","journal-title":"Ann Intern Med"},{"issue":"4","key":"2020121621272787000_B13","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1182\/blood-2016-09-739086","article-title":"Ponatinib efficacy and safety in Philadelphia chromosome\u2013positive leukemia: final 5-year results of the phase 2 PACE trial","volume":"132","author":"Cortes","year":"2018","journal-title":"Blood"},{"issue":"3","key":"2020121621272787000_B14","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1002\/hon.2606","article-title":"Arterial occlusive events in chronic myeloid leukemia patients treated with ponatinib in the real-life practice are predicted by the Systematic Coronary Risk Evaluation (SCORE) chart","volume":"37","author":"Caocci","year":"2019","journal-title":"Hematol Oncol"},{"issue":"1","key":"2020121621272787000_B15","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.thromres.2014.11.009","article-title":"The BCR-ABL inhibitor ponatinib inhibits platelet immunoreceptor tyrosine-based activation motif (ITAM) signaling, platelet activation and aggregate formation under shear","volume":"135","author":"Loren","year":"2015","journal-title":"Thromb Res"},{"issue":"2","key":"2020121621272787000_B16","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1182\/blood-2008-09-180604","article-title":"Tyrosine kinase inhibitor\u2013induced platelet dysfunction in patients with chronic myeloid leukemia","volume":"114","author":"Quint\u00e1s-Cardama","year":"2009","journal-title":"Blood"},{"issue":"14","key":"2020121621272787000_B17","doi-asserted-by":"crossref","first-page":"1597","DOI":"10.1182\/blood-2018-10-881557","article-title":"Thrombotic microangiopathy as a cause of cardiovascular toxicity from the BCR-ABL1 tyrosine kinase inhibitor ponatinib","volume":"133","author":"Latifi","year":"2019","journal-title":"Blood"},{"issue":"1","key":"2020121621272787000_B18","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1182\/asheducation-2017.1.110","article-title":"Cardiovascular care of patients with chronic myeloid leukemia (CML) on tyrosine kinase inhibitor (TKI) therapy","volume":"2017","author":"Barber","year":"2017","journal-title":"Hematology (Am Soc Hematol Educ Program)"},{"issue":"35","key":"2020121621272787000_B19","doi-asserted-by":"crossref","first-page":"4210","DOI":"10.1200\/JCO.2015.62.4718","article-title":"Tyrosine kinase inhibitor\u2013associated cardiovascular toxicity in chronic myeloid leukemia","volume":"33","author":"Moslehi","year":"2015","journal-title":"J Clin Oncol"},{"issue":"7","key":"2020121621272787000_B20","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1002\/clc.22137","article-title":"A clinician\u2019s guide to the ABCs of cardiovascular disease prevention: the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease and American College of Cardiology Cardiosource Approach to the Million Hearts Initiative","volume":"36","author":"Hsu","year":"2013","journal-title":"Clin Cardiol"},{"issue":"32","key":"2020121621272787000_B21","doi-asserted-by":"crossref","first-page":"33944","DOI":"10.18632\/oncotarget.5580","article-title":"Effects of first- and second-generation tyrosine kinase inhibitor therapy on glucose and lipid metabolism in chronic myeloid leukemia patients: a real clinical problem?","volume":"6","author":"Iurlo","year":"2015","journal-title":"Oncotarget"},{"issue":"5","key":"2020121621272787000_B22","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1016\/j.ando.2018.07.011","article-title":"Expert opinion on the metabolic complications of new anticancer therapies: tyrosine kinase inhibitors","volume":"79","author":"Buffier","year":"2018","journal-title":"Ann Endocrinol (Paris)"},{"issue":"7","key":"2020121621272787000_B23","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.3324\/haematol.2014.104075","article-title":"Early onset hypercholesterolemia induced by the 2nd-generation tyrosine kinase inhibitor nilotinib in patients with chronic phase-chronic myeloid leukemia","volume":"99","author":"Rea","year":"2014","journal-title":"Haematologica"},{"issue":"2","key":"2020121621272787000_B24","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1080\/03007995.2017.1399870","article-title":"Incidence of type 2 diabetes mellitus and hyperlipidemia in patients prescribed dasatinib or nilotinib as first- or second-line therapy for chronic myelogenous leukemia in the US","volume":"34","author":"Franklin","year":"2018","journal-title":"Curr Med Res Opin"},{"issue":"8","key":"2020121621272787000_B25","doi-asserted-by":"crossref","first-page":"e75","DOI":"10.1182\/blood-2010-07-294330","article-title":"Drug interactions with the tyrosine kinase inhibitors imatinib, dasatinib, and nilotinib","volume":"117","author":"Haouala","year":"2011","journal-title":"Blood"},{"issue":"25","key":"2020121621272787000_B26","doi-asserted-by":"crossref","first-page":"3908","DOI":"10.1200\/JCO.2007.12.0329","article-title":"Pleural effusion in patients with chronic myelogenous leukemia treated with dasatinib after imatinib failure","volume":"25","author":"Quint\u00e1s-Cardama","year":"2007","journal-title":"J Clin Oncol"},{"issue":"1","key":"2020121621272787000_B27","doi-asserted-by":"crossref","first-page":"93","DOI":"10.3324\/haematol.2018.188987","article-title":"Incidence, outcomes, and risk factors of pleural effusion in patients receiving dasatinib therapy for Philadelphia chromosome\u2013positive leukemia","volume":"104","author":"Hughes","year":"2019","journal-title":"Haematologica"},{"issue":"9","key":"2020121621272787000_B28","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1002\/ajh.24423","article-title":"Dasatinib in imatinib-resistant or -intolerant chronic-phase, chronic myeloid leukemia patients: 7-year follow-up of study CA180-034","volume":"91","author":"Shah","year":"2016","journal-title":"Am J Hematol"},{"issue":"1","key":"2020121621272787000_B29","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1002\/cncr.32504","article-title":"Long-term follow-up of lower dose dasatinib (50 mg daily) as frontline therapy in newly diagnosed chronic-phase chronic myeloid leukemia","volume":"126","author":"Naqvi","year":"2020","journal-title":"Cancer"},{"issue":"2","key":"2020121621272787000_B30","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.clml.2016.09.012","article-title":"Pleural effusion in dasatinib-treated patients with chronic myeloid leukemia in chronic phase: identification and management","volume":"17","author":"Cortes","year":"2017","journal-title":"Clin Lymphoma Myeloma Leuk"},{"key":"2020121621272787000_B31","first-page":"684","article-title":"Effects of bosutinib treatment on renal function in patients with Philadelphia chromosome\u2013positive leukemias","volume-title":"Clin Lymphoma Myeloma Leuk.","author":"Cortes","year":"2017"},{"issue":"21","key":"2020121621272787000_B32","doi-asserted-by":"crossref","first-page":"3894","DOI":"10.1002\/cncr.29587","article-title":"Estimated glomerular filtration rate changes in patients with chronic myeloid leukemia treated with tyrosine kinase inhibitors","volume":"121","author":"Yilmaz","year":"2015","journal-title":"Cancer"},{"issue":"10","key":"2020121621272787000_B33","doi-asserted-by":"crossref","first-page":"1803","DOI":"10.1007\/s00277-018-3375-9","article-title":"Changes in estimated glomerular filtration rate in chronic myeloid leukemia patients treated front line with available TKIs and correlation with cardiovascular events","volume":"97","author":"Molica","year":"2018","journal-title":"Ann Hematol"},{"issue":"13","key":"2020121621272787000_B34","doi-asserted-by":"crossref","first-page":"3152","DOI":"10.1002\/cncr.25071","article-title":"Imatinib front-line therapy is safe and effective in patients with chronic myelogenous leukemia with pre-existing liver and\/or renal dysfunction","volume":"116","author":"Tong","year":"2010","journal-title":"Cancer"},{"issue":"3","key":"2020121621272787000_B35","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.clml.2015.12.003","article-title":"Clinical safety and efficacy of nilotinib or dasatinib in patients with newly diagnosed chronic-phase chronic myelogenous leukemia and pre-existing liver and\/or renal dysfunction","volume":"16","author":"Sasaki","year":"2016","journal-title":"Clin Lymphoma Myeloma Leuk"},{"issue":"4","key":"2020121621272787000_B36","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1007\/s00280-005-1031-2","article-title":"Pharmacokinetics of imatinib mesylate in end stage renal disease. A case study","volume":"56","author":"Pappas","year":"2005","journal-title":"Cancer Chemother Pharmacol"},{"issue":"1","key":"2020121621272787000_B37","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1007\/s12185-020-02846-5","article-title":"Pharmacokinetics of dasatinib in a hemodialysis patient with chronic myeloid leukemia and chronic kidney disease","volume":"112","author":"Mori","year":"2020","journal-title":"Int J Hematol"},{"issue":"23","key":"2020121621272787000_B38","doi-asserted-by":"crossref","first-page":"1587","DOI":"10.1182\/blood.V126.23.1587.1587","article-title":"Survival impact of patients (pts) with chronic myeloid leukemia (CML) due to failure from the use of one or more tyrosine kinase inhibitors (TKI)","volume":"126","author":"Akosile","year":"2015","journal-title":"Blood"},{"issue":"suppl","key":"2020121621272787000_B39","doi-asserted-by":"crossref","first-page":"abstr. 7502","DOI":"10.1200\/JCO.2020.38.15_suppl.7502","article-title":"Interim analysis (IA) of OPTIC: a dose-ranging study of three ponatinib (PON) starting doses","volume":"38","author":"Cortes","year":"2020","journal-title":"J Clin Oncol"},{"issue":"6","key":"2020121621272787000_B40","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1002\/ajh.24360","article-title":"Long-term evaluation of cardiac and vascular toxicity in patients with Philadelphia chromosome\u2013positive leukemias treated with bosutinib","volume":"91","author":"Cortes","year":"2016","journal-title":"Am J Hematol"}],"container-title":["Hematology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/ashpublications.org\/hematology\/article-pdf\/2020\/1\/237\/1795115\/hem2020006911c.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/ashpublications.org\/hematology\/article-pdf\/2020\/1\/237\/1795115\/hem2020006911c.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,12,18]],"date-time":"2020-12-18T18:20:14Z","timestamp":1608315614000},"score":1,"resource":{"primary":{"URL":"https:\/\/ashpublications.org\/hematology\/article\/2020\/1\/237\/474360\/How-to-manage-CML-patients-with-comorbidities"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,4]]},"references-count":40,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12,4]]}},"URL":"https:\/\/doi.org\/10.1182\/hematology.2020006911","relation":{},"ISSN":["1520-4391","1520-4383"],"issn-type":[{"value":"1520-4391","type":"print"},{"value":"1520-4383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,4]]}}}