Patient-reported toxicity symptoms during tyrosine kinase inhibitor treatment in chronic myeloid leukemia: a systematic review and meta-analysis.

PURPOSE: One in five chronic myeloid leukemia (CML) patients experiences such intolerability that they switch tyrosine kinase inhibitor (TKI) treatment within 3 years. Information on tolerability is needed to guide shared decision-making. However, an overview of symptoms patients experience per TKI is lacking, and physician-graded toxicity underestimates patients' experiences.

METHODS

We systematically searched PubMed and Embase from inception to February 2025 and conducted a meta-analysis on the prevalence of patient-reported symptoms in CML per TKI. This study follows the Preferred Reporting Items for Systematic Reviews (PRISMA) guideline for systematic reviews.

RESULTS

We included 11 studies with 2987 patients, reporting on 47 different symptoms of any severity. The low-grade patient-reported symptom burden was high. No data were available on asciminib and ponatinib, and minimal data were available for bosutinib. In indirect, unadjusted comparisons, 13 out of 47 symptoms (of any severity) showed significant differences in prevalence between common TKI types.

CONCLUSION

Our findings provide essential information to guide treatment decisions in cases of intolerability. However, there is a clear need for further research with standardized instruments, especially in second and third generation TKI types, including direct comparisons and comparisons adjusted for covariates.