How to manage CML patients with comorbidities

Patients with chronic myeloid leukemia (CML) frequently have co-morbidities, 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 co-morbidities might be the most significant adverse feature for long-term survival. The presence of co-morbidities may also affect the risk of developing adverse events with TKIs. This is perhaps best exemplified by the risk of developing arterio-occlusive events which is greatest with patients that have other risk factors for such events, with the risk increasing with higher numbers of co-morbidities. The coexistence of co-morbidities in patients with CML may not only affect the selection of TKI, but also demands close monitoring of the overall health condition of the patient to optimize safety and provide the opportunity of an optimal outcome to such patients. With an optimal, holistic management of the patient, their leukemia and all other conditions afflicting them, CML patients with co-morbidities may too aim for a near-normal life expectancy, just as the more selected patients enrolled in clinical trials now enjoy.