Chronic myeloid leukemia and imatinib: Experience at the Lome Campus teaching hospital (Togo)

Segbena, A.; Agbetiafa, Komlan; Padaro, E; Layibo, Yao; Dorkenoo, A; Agbo, YM; Bories, D.

doi:10.1684/mst.2012.0083

Cited by 5 publications

(2 citation statements)

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“…Also, the frequency of patients with unfavorable Sokal risk group (including intermediate and high) was high (74.5 %) in our cohort. Similar rates are common in the developing countries, 83.4 % in Cote d'Ivoire [15] and 80 % in Togo [16]. Conversely, in developed countries, most patients have a better prognosis at diagnosis.…”

Section: Discussionmentioning

confidence: 61%

Pattern of chronic myeloid leukemia in the imatinib era in a Sub-Saharan African setting

et al. 2016

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Chronic myeloid leukemia (CML) is an orphan disease in Africa because of the inaccessibility to specific treatment and the high cost of diagnosis and monitoring patients. The aim of this study was to report CML treatment response in a developing country in the tyrosine kinase inhibitor era. We conducted a longitudinal study of our cohort of CML patients. Socio-demographic, diagnosis, therapeutic, and treatment response parameters were studied. Sokal score, disease phase at diagnosis, delay from diagnosis to treatment, and treatment response were analyzed for their impact on survival. Fifty-five patients with a diagnosis of CML and who received treatment with imatinib for a minimum of 3 months were included in this study. Median follow-up was 170 patient-years. The sex ratio (M/F) was 1.62 and median age at diagnosis was 42 years. At diagnosis, 85.5 % of the patients were in chronic phase (CP), 12.7 % in accelerated phase (AP), and 1.8 % in blast crisis (BC). Sokal risk score distribution was as follows: low risk 29.8 %, intermediate risk 38.3 %, and high risk 31.9 %. Median time from first symptoms to first medical visit was 6.2 months and median time from first medical visit to cytogenetic and or molecular confirmation was 12.4 months. Mean delay time from first medical visit to imatinib initiation was 12.5 months (95 % CI 6.3-18.7). The complete hematologic response (CHR) at 3 months, the major cytogenetic response (MCR) at 12 months, and the major molecular response (MMR) at 24 months were respectively 82.4, 75, and 25 %. The 2-year overall survival rate was 81 %. Advanced phase at the diagnosis, discontinuation of imatinib therapy over 15 % of the time, lack of CHR at 3 months, lack of MCR at 12 months, and progression of the disease during imatinib therapy were associated with a risk of death (p ≤ 0.05). Our data confirm the improved prognosis of CML treated with imatinib in the setting of a developing country. However, response rates are lower than in developed countries, and additional efforts should be made to facilitate early diagnosis and improve access to TKI, treatment compliance, and regular molecular monitoring of patients.

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Section: Discussionmentioning

confidence: 61%

Pattern of chronic myeloid leukemia in the imatinib era in a Sub-Saharan African setting

et al. 2016

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“…A recent United States–based study revealed that high adherence rates were critical to achieving and maintaining major molecular response in CML. 15 Drug cost, inconvenience, toxicity, and lack of understanding of the importance of compliance all contribute to poor drug adherence. The fact that our patients achieved and maintained hematologic remission suggests that there is an acceptable rate of medication adherence, although formal evaluation of adherence should be performed in the future.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Chronic Myeloid Leukemia in Rural Rwanda: Promising Early Outcomes

Tapela

Nzayisenga

Sethi

et al. 2016

JGO

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PurposeThe burden of cancer is rising in low- and middle-income countries, yet cancer treatment requires resources that are often not available in these settings. Although management of chronic myeloid leukemia (CML) has been described in low- and middle-income countries, few programs involve patients treated in rural settings. We describe characteristics and early outcomes of patients treated for CML at rural district hospitals in Rwanda.MethodsWe conducted a retrospective review of patients with confirmed BCR-ABL–positive CML who were enrolled between July 1, 2009 and June 30, 2014. Types of data included patient demographics, diagnostic work up, treatment, clinical examination, laboratory testing, and death.ResultsForty-three patients were included, with a maximum follow-up of 58 months. Of 31 patients who were imatinib-naïve at enrollment, 54.8% were men and the median age at diagnosis was 36.9 years (interquartile range: 29-42 years). Approximately two-thirds of patients (67.7%) were on the national public insurance scheme. The imatinib dose was reduced for 16 patients and discontinued for five. Thirty-two of the 43 patients continued to have normal blood counts at last follow-up. Four patients have died and four are lost to follow-up.ConclusionOur experience indicates that CML can be effectively managed in a resource-constrained rural setting, despite limited availability of on-site diagnostic resources or specialty oncology personnel. The importance of model public-private partnerships as a strategy to bring high-cost, life-saving treatment to people who do not have the ability to pay is also highlighted.

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A Ten-Year Experience of Treating Chronic Myeloid Leukemia in Rural Rwanda: Outcomes and Insights for a Changing Landscape

Morgan¹,

DeBoer

Bigirimana³

et al. 2022

JCO Global Oncology

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PURPOSE In describing our ten-year experience with treating chronic myeloid leukemia (CML) as part of the Glivec Patient Assistance Program (GIPAP) in rural Rwanda, we evaluate (1) patient characteristics and treatment outcomes, (2) resource-adapted management strategies, and (3) the impact of diagnostic capacity development. METHODS We retrospectively reviewed all patients with BCR-ABL–positive CML enrolled in this GIPAP program between 2009 and 2018. Clinical data were analyzed using descriptive statistics, Kaplan-Meier methods, proportional hazards regression, and the Kruskal-Wallis test. RESULTS One hundred twenty-four patients were included. The median age at diagnosis was 34 (range 8-81) years. On imatinib, 91% achieved complete hematologic response (CHR) after a median of 49 days. Seven (6%) and 12 (11%) patients had primary and secondary imatinib resistance, respectively. The 3-year overall survival was 80% (95% CI, 72 to 87) for the cohort, with superior survival in imatinib responders compared with those with primary and secondary resistance. The median time from imatinib initiation to CHR was 59 versus 38 days ( P = .040) before and after in-country diagnostic testing, whereas the median time to diagnosis ( P = .056) and imatinib initiation ( P = .170) was not significantly different. CONCLUSION Coupling molecular diagnostics with affordable access to imatinib within a comprehensive cancer care delivery program is a successful long-term strategy to treat CML in resource-constrained settings. Our patients are younger and have higher rates of imatinib resistance compared with historic cohorts in high-income countries. High imatinib resistance rates highlight the need for access to molecular monitoring, resistance testing, and second-generation tyrosine kinase inhibitors, as well as systems to support drug adherence. Hematologic response is an accurate resource-adapted predictor of survival in this setting. Local diagnostic capacity development has allowed for continuous, timely CML care delivery in Rwanda.

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Chronic myeloid leukemia and imatinib: Experience at the Lome Campus teaching hospital (Togo)

Cited by 5 publications

References 0 publications

Pattern of chronic myeloid leukemia in the imatinib era in a Sub-Saharan African setting

Pattern of chronic myeloid leukemia in the imatinib era in a Sub-Saharan African setting

Treatment of Chronic Myeloid Leukemia in Rural Rwanda: Promising Early Outcomes

A Ten-Year Experience of Treating Chronic Myeloid Leukemia in Rural Rwanda: Outcomes and Insights for a Changing Landscape

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