You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Evaluation of tolerability and efficacy of imatinib mesylate in elderly patients with chronic phase CML: ELDERGLI study.
Abstract 1:
Imatinib mesylate ( IM ) is the treatment of choice in patients with newly diagnosed chronic myeloid leukemia ( CML ) , irrespectively of their age . Nevertheless , information regarding tolerability and responses in advanced-age patients , a subgroup in which co-morbidities and other factors may influence outcome , is scarce , since they were excluded from most clinical trials . In this observational study ( ELDERGLI ) , information regarding demographics , concomitant medication , physical examination , performance status , hemogram , biochemistry , hematologic , cytogenetic and molecular responses , time to progression , adverse events ( AE ) and severe adverse events ( SAE ) were prospect ively recorded in a series of 36 elderly patients with CML , with a median age of 76.6 years . Most patients had cardiovascular co-morbidities , especially hypertension . Regarding  IM toxicity , around one third of patients required treatment interruptions because of adverse events , especially hematologic toxicity ( 66 % of cases that needed dose interruptions ) . When analyzing non hematologic adverse events , the most frequent ones were superficial edemas and GI symptoms . Of note , 9 of patients experienced an infection episode during the follow-up , and 4 were diagnosed during the study period of another type of cancer . Finally , cardiovascular events were reported in 7 patients , most of them with prior cardiovascular risk factors . Regarding responses , after 12 months of imatinib therapy , the rate of complete hematologic response ( CHR ) , complete cytogenetic response ( CCyR ) and major molecular response ( MMolR ) were 89 % , 72 % and 55 % respectively . In summary , IM display , in advanced-age patients with chronic phase CML , an efficacy and safety profile comparable to younger patients


Title 2:
Gender aspects in chronic myeloid leukemia: long-term results from randomized studies
Abstract 2:
Gender-related aspects in chronic myeloid leukemia ( CML ) have not been studied well . We therefore analyzed 856 patients with Ph/BCR-ABL-positive CML from the German r and omized CML- studies I ( interferon α ( IFN ) vs hydroxyurea ( HU ) vs busulfan ) and II ( IFN+HU vs HU alone ) . The median observation time was 8.6 years . A total of 503 patients ( 59 % ) were male . Female patients were older ( 51 vs 46 years ; P<0.0001 ) , presented with lower hemoglobin ( 11.7 vs 12.5 g/dl ; P<0.0001 ) , higher platelet counts ( 459 vs 355 × 109/l ; P<0.0001 ) , smaller spleen size ( 3 vs 4 cm below costal margin ; P=0.0097 ) , a lower rate of additional cytogenetic aberrations ( 9 vs 15 % ; P=0.018 ) and a less favorable risk profile ( P=0.036 ) . The transplantation rate was 14 % for female ( n=48 ) and 22 % for male patients ( n=113 ) . Median survival was longer in female patients ( 58 vs 49 months ; P=0.035 ) mainly attributable to better survival in the low- and intermediate-risk groups and , independent from risk groups , in the HU group . These results were confirmed by matched-pair analyses based on German population data ( n=496 , 59 vs 45 months ; P=0.0006 ) . This is the first analysis of gender aspects in CML using r and omized trials . It demonstrates the relevance of analyses of gender differences in CML and in malignant disease at large


Title 3:
Frontline imatinib treatment of chronic myeloid leukemia: no impact of age on outcome, a survey by the GIMEMA CML Working Party.
Abstract 3:
The median age of chronic myeloid leukemia ( CML ) patients is ~60 years , and age is still considered an important prognostic factor , included in Sokal and EURO risk scores . However , few data are available about the long-term outcome of older patients treated with imatinib ( IM ) frontline . We analyzed the relationship between age and outcome in 559 early chronic-phase CML patients enrolled in 3 prospect i ve clinical trials of Gruppo Italiano Malattie Ematologiche dell'Adulto CML Working Party , treated frontline with IM , with a median follow-up of 60 months . There were 115 older patients ( ≥ 65 years ; 21 % ) .  The complete cytogenetic and major molecular response rates were similar in the 2 age groups . In older patients , event-free survival ( 55 % vs 67 % ) , failure-free survival ( 78 % vs 92 % ) , progression-free survival ( 62 % vs 78 % ) , and overall survival ( 75 % vs 89 % ) were significantly inferior ( all P < .01 ) because of a higher proportion of deaths that occurred in complete hematologic response , therefore unrelated to CML progression ( 15 % vs 3 % , P < .0001 ) . The outcome was similar once those deaths were censored . These data show that response to IM was not affected by age and that the mortality rate linked to CML is similar in both age groups . This trial was registered at www . clinical trials.gov as # NCT00514488 and # NCT00510926


Title 4:
Result of interferon-alpha therapy in patients with chronic myelogenous leukemia 60 years of age and older.
Abstract 4:
PURPOSE To determine the response rate to interferon-alpha ( IFN-alpha ) in patients with chronic myelogenous leukemia ( CML ) aged 60 years and older . PATIENTS AND METHODS Patients with CML aged 60 years and older included in all protocol s with INF-alpha therapy for chronic phase CML at the M.D. And erson Cancer Center were analyzed . They were treated with human leukocyte or recombinant human IFN-alpha 5x10(6 ) U/m2 daily alone or in combination with hydroxyurea or IFN gamma . The clinical characteristics of the patients were analyzed and their hematologic and cytogenetic responses to IFN-alpha and survival from the initiation of therapy were determined . Results were compared with those of younger patients treated in the same protocol s. Treatment-related toxicity was also analyzed . RESULTS Thirty-five of 274 ( 13 % ) patients included in trials of IFN-alpha-based regimens for CML were 60 years and older . Older patients had a higher percentage of bone marrow blasts ( P = 0.04 ) and basophils ( P = 0.09 ) than younger patients . Sixty-nine percent achieved a complete hematologic remission with IFN-alpha therapy , and 51 % had a cytogenetic response , which was major in 26 % and complete ( Philadelphia chromosome-positive cells = 0 % ) in 20 % , Their median survival was 64 months , and the estimated 5-year survival rate was 62 % . These results were not different from those in younger patients . Twenty-two patients ( 63 % ) had at least grade 2 toxicity requiring dose adjustment . The most frequent side effects were neurotoxicity in 31 % and chronic fatigue in 29 % . CONCLUSIONS Patients with CML 60 years of age and older respond well to IFN-alpha therapy , but experience more toxicity . This therapy should be considered for these patients if they are otherwise in good condition , with careful attention to IFN-alpha toxicity and its management


Title 5:
Elderly patients with Ph+ chronic myelogenous leukemia (CML): results of imatinib mesylate treatment.
Abstract 5:
Thirty-five patients with Ph+ CML aged more than 60 years were treated with imatinib . Twenty-four patients ( group A ) were in late chronic phase ( CP ) and eleven patients ( group B ) were in accelerated/blastic phase ( AP/BP ) . In group A , complete haematological response ( CHR ) was achieved by all patients ; seventeen patients ( 70.8 % ) attained a complete cytogenetic response ( CCR ) , one ( 4.1 % ) attained a partial CR , one ( 4.1 % ) a minor CR ( Ph+ 70 % ) and five ( 21 % ) were resistant ( Ph+ 100 % ) , toxicity was mild : seven patients had a transient cytopenia , three a skin reaction , one a moderate oedema and one muscular pain . After a median follow-up of 15 months , 1 patient died in progression and 23 patients are alive ( 2 in BP and 21 in persisting response ) . In group B , one patient died after 3 months in aplastic phase from sepsis , three patients were resistant and seven patients ( 63.7 % ) achieved CHR ; of these , four obtained CCR . After a median follow-up of 17 months , 4 patients have died from progressive disease , 6 are alive ; 1 in AP and 5 in CHR ( 4 of them being in CCR ) . Present data indicate that imatinib is safe also in elderly with clinical results as good as in younger patients


Title 6:
Chronic myeloid leukemia in the elderly: long-term results from randomized trials with interferon alpha.
Abstract 6:
Chronic myeloid leukemia ( CML ) in older patients has not been studied well . To assess the long-term outcome of older patients with Philadelphia- and /or BCR-ABL-positive CML , 199 patients aged > /=60 years representing 23 % of 856 patients enrolled in the German r and omized CML- studies I  ( interferon alpha ( IFN ) vs hydroxyurea ( HU ) vs busulfan ( BU ) and II ( IFN+HU vs HU alone ) were analyzed after a median observation time of 7 years . In all , 45 patients were treated with Bu , 63 with HU , and 91 with IFN . The 5-year survival was 38 % in patients > /=60 years and 47 % in patients < 60 years ( P<0.001 ) . Whereas 5-year survival in chemotherapy-treated older patients was inferior to that in younger patients ( 33 vs 46 % , P=0.006 for HU and 29 vs 38 % , P=0.042 for Bu ) , no significant survival difference could be verified in IFN-treated patients ( 46 vs 53 % , P=0.077 ) . Calculation of age-adjusted , relative survival confirmed these results . Adverse effects of IFN were similar in both age groups , but IFN dosage to achieve treatment goals was lower in older patients . We conclude that the course of CML is not different in the elderly . They require lower IFN doses , achieve the same hematologic and cytogenetic response rates and the same survival advantage at comparable toxicity


Title 7:
Impact of age on the outcome of patients with chronic myeloid leukemia in late chronic phase: results of a phase II study of the GIMEMA CML Working Party.
Abstract 7:
To assess the effect of age on response and compliance to treatment in patients with chronic myeloid leukemia ( CML ) we performed a sub- analysis within a phase II trial of the GIMEMA CML Working Party ( CML/002/STI571 ) . Since the WHO cut-off age to define an older patient is 65 years , among the 284 patients considered , we identified 226 ( 80 % ) younger patients ( below 65 years ) and 58 ( 20 % ) older patients ( above 65 years ) before starting imatinib .  Response rates ( hematologic and cytogenetic ) were lower in the older age group but the probabilities of progression-free survival and overall survival ( median observation time 3 years ) were the same . Moreover , among complete cytogenetic responders , no differences were found in the level of molecular response between the two age groups . As might be expected , older patients experienced more adverse events , both hematologic and non-hematologic : this worsened compliance did not , however , prevent a long-term outcome similar to that of younger patients
Imatinib in newly diagnosed older patients showed similar rate of cytogenetic and molecular responses compared to younger patients .
The aim of this review is , through the revision of published data , to highlight the fact that elderly CML patients can benefit from target therapy with limited adverse events