Treating Philadelphia chromosome/BCR‐ABL1 positive patients with Glivec (Imatinib mesylate): 10 years’ experience at Patan Hospital, Nepal

Abstract

Summary The Glivec International Patient Assistance Programme makes Glivec (Imatinib mesylate) available to Philadelphia chromosome/BCR‐ABL1 positive patients with chronic myeloid leukaemia (CML) in Lower and Middle Income Countries (LMIC). We have established a large cohort of 211 CML patients who are eligible for Imatinib, in Kathmandu, Nepal. Thirty‐one patients were lost to follow‐up. We report on 180 CML patients with a median age of 38 years (range 9–81). Of these 180 patients, 162 underwent cytogenetic testing and 110 were investigated by reverse transcription polymerase chain reaction. One hundred and thirty‐nine of the 180 patients (77·2%) had at least one optimal response. Taken together, our cohort has a 95% overall survival rate and 78% of the patients were still taking Glivec at a median time of 48·8 months (range 3–140 months). The number of patients who actually failed therapy, as defined by the LeukaemiaNet 2013 criteria, was 39 (21·7%). While our cohort has some differences with those in North America or Europe, we have shown Glivec is effective in inducing an optimal response in our patients in Nepal and that it is possible to deliver a clinical service for CML patients using tyrosine kinase inhibitors in resource‐poor settings.

Response to Tyrosine Kinase Inhibitors in Patients with BCR-ABL1 Positive Chronic Myeloid Leukemia; 13.5 Years’ Experience at Patan Hospital, Nepal

“…Although there are many controlled studies in the developed world, there are no reports of studies with long follow up in resource poor setting. We have published 4 articles with regard to response and resistance in our patients with CML [13][14][15][16]. We hypothesize that the survival in our set up is similar to well controlled studies elsewhere.…”

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

“…9 Numerous individual studies have demonstrated the efficacy and safety of GIPAP-facilitated CML treatment in LMICs; however, most care delivery programs have been implemented in private sectors or urban academic centers, with few in sub-Saharan Africa. [10][11][12][13][14] In Rwanda, a CML care delivery program was developed at two rural public hospitals, Rwinkwavu and Butaro Hospitals, in 2009 through collaboration between GIPAP, the Rwanda Ministry of Health (RMOH), the organization Partners In Health (PIH), and advisors from Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC). 15,16 Initially, in-country diagnostic testing was unavailable, and blood and bone marrow specimens were shipped to DF/BWCC for diagnostic confirmation of CML.…”