Report of chronic myeloid leukemia SMS Medical College Hospital, Jaipur

Abstract

This is a retrospective analysis of patients of chronic myeloid leukemia (CML) registered and under treatment at the Leukemia Lymphoma Clinic at the Birla Cancer Center, SMS Medical College Hospital, Jaipur. Approximately, two-thirds of the patients are getting imatinib mesylate (IM) through the Glivec International Patient Assistance Program while the rest are on generic IM. In addition to comparison of hematological and molecular responses in the Glivec versus the genetic group, in this analysis, an attempt is also made to assess the socio-economic (SE) status of the patients and its effect on the response rates. Of the 213 patients studied, most (28.6%) are in the age group between 30 years and 40 years and the mean age of the patients in 39 years, a good decade younger that in the west. There is a suggestion that patients in lower SE class present with higher Sokal scores and with more disease burden. Possibly hematological responses are similar with both Glivec and generic IM. No comment can be made with regards to molecular response between the two groups as a significant number of patients in the Glivec arm (42%) do not have molecular assessment because of economic reasons. CML is a common and challenging disease in the developing world with patients presenting at an earlier age with more advanced disease. SE factors play a significant role in therapy and disease monitoring decision making and may impact on response rates and prognosis.

Summary of the published Indian data on chronic myeloid leukemia

“…It is noteworthy that patients in lower socioeconomic (SE) class presented with higher Sokal scores and with more disease burden as described from SMS Medical College Hospital, Jaipur, indicating probably a late diagnosis. [25] Interestingly, the data from TMH, Mumbai, Maharashtra, India, showed that irrespective of the Sokal score, the CCyR was similar, i.e., for low risk (76.3%), intermediate risk (73.8%), and high risk (77.3%), suggesting that IM may overcome this aspect of disease. [15] Studies from TMH and SMS, Jaipur, also compared the responses of innovator Glivec to the Indian IM and found similar hematological responses, cytogenetic and better molecular responses with generic.…”

“…[15] Studies from TMH and SMS, Jaipur, also compared the responses of innovator Glivec to the Indian IM and found similar hematological responses, cytogenetic and better molecular responses with generic. [15,25] Unfortunately, a significant number of patients in the Glivec arm were not tested for molecular responses for economic reasons making the difference artifactual.…”

“…Name of center CHR % CCyR % > MMolR% Imatinib resistance NIMS, Hyderabad [10] 97 56 NA 18 SMS, Jaipur [25] 96 NA 32 47 (generic) NA SEAROC, Jaipur [26] 93 NA 80 9 TMH, Mumbai [15] 98.7 72 75 (generic)…”

The efficacy of generic imatinib in patients with chronic myeloid leukemia: A single centre experience

“…It may be noted that cytogenetic and molecular responses were better in the group of patients treated with generic imatinib. These results could be explained by the fact that molecular responses were not documented in 42% of patients in the Glivec arm because of economic reasons 16 .…”

“…MMR rate was quite similar between these two groups 15 . The other study from India included 213 patients of CML [16]. 64% of patients were on GIPPAR Glivec, while 36% are on generic imatinib.…”