酪氨酸激酶抑制剂（TKI）的使用对患有慢性髓细胞白血病（CML）的患者的护理至关重要。建议在TKI治疗的第一年每3个月进行一次定量BCR-ABL1聚合酶链反应（qPCR）检测，以确保达到里程碑反应目标。对于老年患者群体的qPCR监测和TKI依从性的真实世界证据尚缺。使用监测、流行病学和结果-医疗保险数据库，我们确定了1192例年龄>66岁（中位年龄74岁）新诊断的CML患者，从TKI开始治疗后随访≥13个月。其中965名患者（81.0%）进行了至少1次测试，其中有425例（35.7%）和540例（45.3%）的患者在1-2个季度和≥3个季度（最佳监测）的第一年向TKI开始治疗。在多变量分析中，后期诊断（与2007-2010相比，2011-2014的比率机会[OR]=1.97，95%置信区间[CI]: 1.43-2.7，p<0.01；2015-2017 OR=2.33，95%CI: 1.66-3.27，p<0.01）和流感疫苗在诊断前接种，作为医疗保健获取的代理（OR=1.31，95％CI：1.01-1.70，p=0.04）与最佳qPCR监测有关。低收入补贴的使用和居住在具有最低社会经济地位的人口普查区域与最不理想的监测有关。进行最佳监测的患者更有可能遵循TKI治疗（OR=1.60，95％CI：1.11-2.31，p=0.01），并且存活5年的情况得到改善（风险比=0.66，95％CI：0.49-0.90，p<0.01）。在这项大规模的“真实世界”CML管理模式研究中，许多老年患者的分子监测不够理想，这与TKI依从性下降和较差的存活率有关。 Copyright © 2023 American Society of Hematology。

Tyrosine kinase inhibitor (TKI) use is critical to the care of patients with chronic myeloid leukemia (CML). Quantitative BCR-ABL1 polymerase chain reaction (qPCR) testing every 3 months during the first year of TKI treatment is recommended to assure achievement of milestone response goals. Real-world evidence for the patterns of qPCR monitoring and TKI adherence in the older patient population is lacking. Using the Surveillance, Epidemiology, and End Results-Medicare database we identified 1192 patients aged >66 years (median age of 74 years) with newly-diagnosed CML followed for ≥13 months from TKI initiation. Nine hundred sixty five patients (81.0%) had at ≥1 test with 425 (35.7%) and 540 (45.3%) of patients tested during 1-2 and ≥3 quarters (optimal monitoring) of the first year from TKI initiation, respectively. In multivariable analysis, diagnosis in later years (compared with 2007-2010, 2011-2014 odds ratio [OR]=1.97, 95% confidence interval [CI]: 1.43-2.7, p<0.01; 2015-2017 OR=2.33, 95%CI: 1.66-3.27, p<0.01) and influenza vaccination before diagnosis, a proxy for healthcare access (OR=1.31, 95%CI: 1.01-1.70, p=0.04) were associated with optimal qPCR monitoring. Use of low-income subsidy and residing in census tracts with the lowest socioeconomic status were associated with less optimal monitoring. Patients with optimal monitoring were 60% more likely to be TKI adherent (OR=1.60, 95%CI: 1.11-2.31, p=0.01) and had improved 5-year survival (hazard ratio=0.66, 95%CI: 0.49-0.90, p<0.01). In this large "real-world" study of CML management patterns, many older patients had suboptimal molecular monitoring, which was associated with decreased TKI adherence and worse survival.Copyright © 2023 American Society of Hematology.