 scientists shows less than a third of older patients with chronic myeloid leukemia (CML) had optimal laboratory monitoring and only two-thirds were adherent to TKI therapy during the first year after diagnosis. TKI treatment can provide a “functional cure” of the disease for many patients with the disease. The findings were reported today at the 2021 American Society of Hematology (ASH) Annual Meeting & Exposition in Atlanta, Georgia.

“We were surprised by the proportion of patients that did not receive any and/or optimal laboratory monitoring to assure the therapy they were receiving was in fact working or to guide a change in therapy,” said 

, Assistant Professor of Medicine (Hematology) at Yale Cancer Center and lead author of the study. “We were also surprised that a third of patients were not appropriately adherent to therapy and have concerns that this may have impacted their outcomes.”

For this study, using the SEER-Medicare database, researchers assembled the largest study of 1,192 patients, aged 66-99 years old at diagnosis between 2007-2017 with CML receiving a TKI and followed the patients for at least one year. They found about 20 percent of the patients did not have any evidence guideline-recommended testing and only 28 percent of the patients had “optimal” monitoring. In reviewing adherence to treatment recommendations, they found only 67 percent of patients were reasonably adherent to TKI therapy.

The Yale researchers found that patients with lower socioeconomic status had less laboratory monitoring, but that more recent patients had better monitoring. The team found that adherence to treatment on TKI decreased with increasing age, but improved with later diagnosis (similar to monitoring) as well as with better overall access to healthcare. Lesser monitoring was itself associated with decreased TKI adherence.

“These results highlight areas for improvement in the standards of care for older patients with CML,” said 

, Associate Professor of Medicine (Hematology) at Yale Cancer Center and senior author of the study. “You can only derive benefit from treatment if you take it. Making sure that older patients with CML are adherent to TKI therapy may help to improve their outcomes.”

Funding for the study was provided by the Frederick A. DeLuca Foundation.



About Yale Cancer Center and Smilow Cancer Hospital

 (YCC) is one of only 51 National Cancer Institute-designated comprehensive cancer centers in the nation and the only such center in Connecticut. Cancer treatment for patients is available at Smilow Cancer Hospital through 13 multidisciplinary teams and at 15 Smilow Cancer Hospital Care Centers in Connecticut and Rhode Island. Comprehensive cancer centers play a vital role in the advancement of the NCI’s goal of reducing morbidity and mortality from cancer through scientific research, cancer prevention, and innovative cancer treatment.

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New research led by Yale Cancer Center scientists shows less than a third of older patients with chronic myeloid leukemia had optimal laboratory monitoring and only two-thirds were adherent to TKI therapy during the first year after diagnosis.

Yale Cancer Center Study Shows Many Older Patients with Chronic Myeloid Leukemia Not Appropriately Monitored or Adherent to Prescribed Therapy

 revealed White patients had significantly more telemedicine visits compared with Black patients for hematologic cancer care during the COVID-19 pandemic. Also, in-person visit rates for Black patients were unchanged regardless of treatment category. The findings are being presented today at the 2021 ASH Annual Meeting and Exposition in Atlanta, Georgia.

“We were not surprised by these findings,” said 

, Associate Professor of Internal Medicine (Hematology) at Yale Cancer Center and lead author of the study. “The COVID-19 pandemic impacted healthcare visit trends, propelling healthcare systems to reduce in-person visits and hospital admissions and increasingly rely on telemedicine, but it also heightened the differences in access to technology and care for our patient populations.”

Yale researchers used the nationwide Flatiron Health electronic health record (EHR)-derived de-identified database to select patients with a confirmed diagnosis of acute myeloid leukemia (AML), mantle cell lymphoma (MCL), follicular lymphoma (FL), chronic lymphocytic leukemia (CLL), or Multiple Myeloma (MM), and documented race in the EHR as Black/African American or White. Patients were categorized into treatment types within lines of therapy: Orals (orals + outpatient infusions with orals) vs. Inpatient treatments (chemotherapy, hematopoietic transplants & CAR-T cell therapy). Monthly visit rates were calculated as the number of visits (telemedicine or in-person [in-clinic treatment administration, vitals, and/or labs]) per active patient per 30-day standardized month, except for months in which the patient was considered not active (e.g., no documented therapy, surveillance).

The analysis included 17,621 patients (2,225 Black, 15,396 White) diagnosed with AML, FL, MCL, CLL, or MM. Across all diseases and treatment categories, Black patients had no significant reductions in in-person visit rates throughout the pandemic period compared to the projected rates. There was, however, an 18 percent statistically significant reduction in in-person visit rates for White patients on orals during early pandemic months (March - May 2020) from a projected visit rate of 2.0 visits per patient per month to an actual visit rate of 1.61. There was no significant reduction in in-person visit rates for White patients on inpatient treatments. Telemedicine uptake was significantly higher for White patients compared with Black patients for all diseases combined across all treatment categories.

“These in-person visit rates reflect documented telemedicine use disparities, which requires further study into possible compound causes, including economic and societal factors,” added Neparidze.

New research led by Yale Cancer Center revealed White patients had significantly more telemedicine visits compared with Black patients for hematologic cancer care during the COVID-19 pandemic.

Yale Cancer Center Study Reveals Disparities in Telemedicine Use in Patients with Hematologic Cancers

Ian E. Krop, MD, PhD, has been appointed chief clinical research officer, associate cancer center director for clinical research, and director of the Yale Cancer Center Clinical Trials Office. Krop will start in his new position on March 2, 2022.

“I’m pleased to announce Dr. Krop will work with our leadership team to build on the strengths of our clinical research program and lead our staff and new recruits to advance the mission of our Clinical Trials Office,” said 

, Interim Director of Yale Cancer Center, Interim Physician-in-Chief at Smilow Cancer Hospital, William H. Carmalt Professor of Surgery and Chair of Surgery at Yale School of Medicine. “I’m confident Dr. Krop’s expertise will continue to expand the impact of our clinical and research breakthroughs for our cancer patients and their families.”

An international leader in the clinical care of patients with breast cancer, Krop joins Yale from Dana-Farber Cancer Institute where he is the Associate Chief of the Division of Breast Oncology and an Associate Professor of Medicine at Harvard Medical School. Nationally, he serves as Chief Scientific Officer for the Translational Breast Cancer Research Consortium and the Co-Vice Chair for Correlative Science for the Alliance for Clinical Trials in Oncology. His research efforts have advanced the field through clinical trials that define the next generation of therapies for patients. Krop serves as a member of the NCI Breast Cancer Steering Committee and the Data Monitoring Committee for ECOG/ACRIN. He also serves on the Data and Safety Monitoring Boards for multiple phase III trials.

“I look forward to welcoming Dr. Krop to Smilow Cancer Hospital and Yale Cancer Center and continuing the momentum of advancing care for patients,” said Eric P. Winer, MD, incoming Director of Yale Cancer Center. “Together, we will build and support an internationally recognized clinical research program that will focus on scientific excellence, training the next generation of clinical researchers, and promoting the highest quality clinical and translational investigation.” Dr. Winer began in his new position on February 1, 2022.

Ian E. Krop, MD, PhD, has been appointed chief clinical research officer, associate cancer center director for clinical research, and director of the Yale Cancer Center Clinical Trials Office.

Yale Cancer Center

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Yale Cancer Center Study Shows Many Older Patients with Chronic Myeloid Leukemia Not Appropriately Monitored or Adherent to Prescribed Therapy

Yale Cancer Center Study Reveals Disparities in Telemedicine Use in Patients with Hematologic Cancers

Ian E. Krop, MD, PhD, Named Chief Clinical Research Officer, Associate Cancer Center Director for Clinical Research at Yale Cancer Center