Chronic myeloid leukemia: an overview of the determinants of effectiveness and therapeutic response in the first decade of treatment with imatinib mesylate in a Brazilian hospital

Abstract

BackgroundIn the last decade, there has been a revolution in chronic myeloid leukemia treatment with the introduction of tyrosine kinase inhibitors with imatinib mesylate becoming the frontline therapy. ObjectiveTo evaluate the therapeutic efficacy of imatinib mesylate in treating chronic myeloid leukemia patients and to identify factors related to therapeutic efficacy. MethodsThis retrospective study was based on information obtained from patients' records in the Hematology Service of Hospital Universitário Walter Cantídio of the Universidade Federal do Ceará (HUWC / UFC). All patients diagnosed with chronic myeloid leukemia that took imatinib mesylate for a minimum of 12 months in the period from January 2001 to January 2011 were included. From a population of 160 patients, 100 were eligible for analysis. ResultsThe study population consisted of 100 patients who were mostly male (51%) with ages ranging between 21 and 40 years (42%), from the countryside (59%), in the chronic phase (95%), with high-risk prognostic factors (40%); the prognosis of high risk was not associated with complete hematologic response or complete cytogenetic response, but correlated to complete molecular response or major molecular response. Reticulin condensation was associated with complete hematologic response and complete cytogenetic response. It was found that 53% of patients had greater than 90% adherence to treatment. The high adherence was correlated to attaining complete cytogenetic response in less than 12 months. Moreover,20% of patients had good response. ConclusionSignificant changes are indispensable in the monitoring of patients with chronic myeloid leukemia. Thus, the multidisciplinary team is important as it provides access to the full treatment and not just to medications.

Medication adherence, molecular monitoring, and clinical outcomes in patients with chronic myelogenous leukemia in a large HMO

“…Importantly, we were able to examine clinical outcomes (progression and mortality), in contrast to prior studies that mainly examined molecular response. [5][6][7][8][9][10][11][12]16,19,20 As all KPSC patients had pharmacy medication coverage, we could study outcomes without the confounding effects of variable insurance coverage. For example, a previous case series report from Brazil showed that patients with much lower adherence (because of lack of access to drugs) correlated with a low cytogenetic and molecular response.…”

Adherence and/or discontinuation of imatinib mesylate in patients with chronic myeloid leukemia

“…Among the 14 studies analyzed, seven referred only to adherence, one referred only to discontinuation, five assess adherence and discontinuation and one included only suboptimal adherers. It was evident that few studies have assessed the achievement of cytogenetic and molecular response, which are important parameters for analyzing the absence of Philadelphia chromosome, as well as reduced levels of BCL-ABL rearrangement (Marin et al, 2010;Cid et al, 2013;Reis et al, 2013). In addition, four studies showed adherence rates relatively low to imatinib, such as between 19.0 and 53.0%.…”

“…In addition, four studies showed adherence rates relatively low to imatinib, such as between 19.0 and 53.0%. It has been shown in clinical trials that reduced adherence rates are associated with lower rates of CCR and CMR (Marin et al, 2010;Cid et al, 2013). In the clinical context, several factors may influence adherence to treatment regimens and these include not only those aspects of the treatment, but also patient characteristics (Partridge et al, 2002;Efficace et al, 2012).…”

“…Non-adherence and/or discontinuation to imatinib reduces the possibility of CCR in 18% of CML cases (Ganesan et al, 2011). Thus, the adherence to imatinib can prevent complications or exacerbations of CML caused by treatment failures, which would result in hospitalizations and procedures related to increases in health care costs (Halpern et al, 2009;Cid et al, 2013).…”

Successful treatment of chronic myeloid leukemia with tyrosine kinase inhibitors goes beyond access to drugs

“…This issue of the Revista Brasileira de Hematologia e Hemoterapia carries an article entitled "Chronic myeloid leukemia: an overview of the determinants of effectiveness and therapeutic response in the first decade of treatment with imatinib mesylate in a Brazilian hospital" which states that only 20% of CML patients, most in the chronic phase, had a good response to imatinib therapy ( 2 ) . The authors correlated this low outcome to several variables, including delay to start treatment, the advanced stage of the disease, poor access to medication and lack of proper monitoring, such as cytogenetic and molecular analyses.…”