Original Article

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Blood Res 2021; 56(1):

Published online March 31, 2021

https://doi.org/10.5045/br.2021.2020260

© The Korean Society of Hematology

Real-world management of chronic myeloid leukemia in South Korea: the TARGET survey

Jieun Uhm1, Kyoung Ha Kim2, Hyewon Lee3, Hawk Kim4, Slader Cassandra5, Inkyung Joo6, Chul Won Jung7

Division of Hematology Oncology, Department of Internal Medicine, 1Hanyang University Hospital, Hanyang University College of Medicine, 2Soonchunhyang University College of Medicine, Seoul, 3Division of Tumor Immunology and Center for Hematologic Malignancies, Research Institute and Hospital, National Cancer Center, Goyang, 4Division of Hematology, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, 5Novartis, Ltd., 6Novartis Korea, 7Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Correspondence to : Chul Won Jung, M.D., Ph.D.
Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
E-mail: leukemia1@skku.edu

Received: October 13, 2020; Revised: November 30, 2020; Accepted: December 17, 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background
The global TARGET survey examined real-world management of chronic myeloid leukemia (CML) compared with international guideline recommendations. This report focused on the responses of physicians from South Korea compared with those of physicians from the rest of the world (ROW).
Methods
The self-administered, online survey, comprising 23 questions and clinical case scenarios, was completed between April and August 2017. It was designed to gather information on practicing physicians and local practices for CML diagnosis, disease monitoring, treatment, and adverse event (AE) management.
Results
While there were similarities in the mutation analysis and treatment efficacy between Korea and the ROW, there were also differences in CML management. Initial diagnostic testing was more comprehensive in Korea than in the ROW, and there was significantly better access to standardized polymerase chain reaction testing. Assessment of BCR-ABL levels during the first 12 months of treatment was excellent in Korea, and there was greater frontline use of second-generation BCR-ABL tyrosine kinase inhibitors. Korean physicians were significantly less likely to switch therapy for hematologic AEs. Treatment-free remission was not an important goal of therapy among Korean or ROW physicians.
Conclusion
This study identified some differences in the current CML management between Korea and the ROW; CML management in Korean patients was generally in line with the current guidelines.

Keywords Chronic myeloid leukemia, Management, Tyrosine kinase inhibitors, Real-life practice, Treatment-free remission

Article

Original Article

Blood Res 2021; 56(1): 31-37

Published online March 31, 2021 https://doi.org/10.5045/br.2021.2020260

Copyright © The Korean Society of Hematology.

Real-world management of chronic myeloid leukemia in South Korea: the TARGET survey

Jieun Uhm1, Kyoung Ha Kim2, Hyewon Lee3, Hawk Kim4, Slader Cassandra5, Inkyung Joo6, Chul Won Jung7

Division of Hematology Oncology, Department of Internal Medicine, 1Hanyang University Hospital, Hanyang University College of Medicine, 2Soonchunhyang University College of Medicine, Seoul, 3Division of Tumor Immunology and Center for Hematologic Malignancies, Research Institute and Hospital, National Cancer Center, Goyang, 4Division of Hematology, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, 5Novartis, Ltd., 6Novartis Korea, 7Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Correspondence to:Chul Won Jung, M.D., Ph.D.
Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
E-mail: leukemia1@skku.edu

Received: October 13, 2020; Revised: November 30, 2020; Accepted: December 17, 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background
The global TARGET survey examined real-world management of chronic myeloid leukemia (CML) compared with international guideline recommendations. This report focused on the responses of physicians from South Korea compared with those of physicians from the rest of the world (ROW).
Methods
The self-administered, online survey, comprising 23 questions and clinical case scenarios, was completed between April and August 2017. It was designed to gather information on practicing physicians and local practices for CML diagnosis, disease monitoring, treatment, and adverse event (AE) management.
Results
While there were similarities in the mutation analysis and treatment efficacy between Korea and the ROW, there were also differences in CML management. Initial diagnostic testing was more comprehensive in Korea than in the ROW, and there was significantly better access to standardized polymerase chain reaction testing. Assessment of BCR-ABL levels during the first 12 months of treatment was excellent in Korea, and there was greater frontline use of second-generation BCR-ABL tyrosine kinase inhibitors. Korean physicians were significantly less likely to switch therapy for hematologic AEs. Treatment-free remission was not an important goal of therapy among Korean or ROW physicians.
Conclusion
This study identified some differences in the current CML management between Korea and the ROW; CML management in Korean patients was generally in line with the current guidelines.

Keywords: Chronic myeloid leukemia, Management, Tyrosine kinase inhibitors, Real-life practice, Treatment-free remission

Fig 1.

Figure 1.Most important first-line treatment objectives. The respondents assigned a priority from 1 (most important) to 8 (least important) for the listed first-line treatment objectives.
Abbreviations: AP, accelerated phase; BC, blast crisis; CCyR, complete cytogenetic response; DMR, deep molecular response; EMR, early molecular response; MMR, major molecular response; ROW, rest of the world; TFR, treatment-free remission.
Blood Research 2021; 56: 31-37https://doi.org/10.5045/br.2021.2020260

Fig 2.

Figure 2.Most important factors for attempting TFR. Each of the respondents assigned a priority from 1 (most important) to 7 (least important).
Abbreviations: DMR, deep molecular response; ROW, rest of the world; TFR, treatment-free remission; TKI, tyrosine kinase inhibitor.
Blood Research 2021; 56: 31-37https://doi.org/10.5045/br.2021.2020260

Table 1 . Physicians’ responses regarding how hypothetical patients receiving first-line treatment for chronic-phase CML would be managed based on BCR-ABL levels..

% of respondentsPhysicians’ response (N=41)

Immediately switchRe-evaluate in 30–60 daysWill not switch
ELN-defined optimal response [7]
BCR-ABL level of <0.1% with residual disease at 24 mo
Korea72766
ROW182853
ELN-defined suboptimal response [7]
BCR-ABL level of >10% at 3 mo
Korea56629
ROW155529
BCR-ABL level of 1–10% at 6 mo
Korea26137
ROW135135
BCR-ABL level of 0.1–1% at 12 mo
Korea26334
ROW145233
ELN-defined treatment failure [7]
BCR-ABL level of >10% at 6 mo
Korea761510
ROW76204
BCR-ABL level of >1% at 12 mo
Korea731710
ROW74206

Abbreviations: CML, chronic myeloid leukemia; ELN, European LeukemiaNet; ROW, rest of the world..


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