Treatment Outcomes in CML Patients Treated With Tyrosine Kinase Inhibitors at a Tertiary Teaching Hospital in South Africa.
BACKGROUND
Chronic myeloid leukemia (CML) has become one of the most treatable hematologic neoplasms since the advent of the tyrosine kinase inhibitors (TKIs), but it was not known if similar treatment outcomes could be achieved in a resource-limited country. We tested the hypothesis that, despite challenges to access to second-generation TKIs, excellent responses could be replicated in the setting of limited resources.


METHODS
Records of 58 patients with newly diagnosed CML in the chronic phase treated with TKIs at a tertiary teaching hospital in Cape Town, South Africa between 2003 and 2012 were reviewed and assessed according to European LeukemiaNet (ELN) criteria.


RESULTS
After a median follow-up of 60.5 months, progression-free survival at 60 and 96 months was 79.98% and 68.4%, respectively. Overall survival at 60 and 96 months was 92.9% and 83.6%, respectively. Progression to blast phase at 60 months was associated with poorer survival (P = .0002) but progression to accelerated phase was not (P = .1456). Attainment of a complete cytogenetic response at 12 months (P = .28) or major molecular response at 18 months (P = .268) did not have prognostic significance.


CONCLUSIONS
Despite delays in achievement of the target responses defined according to ELN criteria, the use of imatinib mesylate as a first-line treatment can still result in treatment outcomes comparable with those in developed countries. These data suggest opportunities for improvement and success might be even greater with uninterrupted access to second-generation or newer TKIs.
Department of Internal Medicine, Tygerberg Academic Hospital, University of Stellenbosch, Cape Town, South Africa. Electronic address: sissolak1@telkomsa.net.
Gerhard
G
Sissolak
Department of Internal Medicine, Tygerberg Academic Hospital, University of Stellenbosch, Cape Town, South Africa.
Jacques
J
Badenhorst
Department of Pathology, National Health Laboratory Services (NHLS), University of Stellenbosch and Pathcare Laboratories, Cape Town, South Africa.
Janami
J
Steenkamp
Department of Medicine, Columbia University Medical Center, New York, NY.
Mark
M
Heaney
Department of Medicine, University of the Free State, Bloemfontein and Panorama Mediclinic, Cape Town, South Africa.
Vernon
V
Louw
Department of Haematology and Molecular Medicine, University of the Witwatersrand, Johannesburg, South Africa.
Desmond
D
Schnugh
Department of Haematology and Molecular Medicine, University of the Witwatersrand, Johannesburg, South Africa.
Pascale
P
Willem
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001752:Blast Crisis / Q000188:drug therapy* / Q000401:mortality; D004252:DNA Mutational Analysis; D018572:Disease-Free Survival; D005260:Female; D016044:Fusion Proteins, bcr-abl / Q000235:genetics; D006784:Hospitals, Teaching; D006801:Humans; D053208:Kaplan-Meier Estimate; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D020125:Mutation, Missense; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D013019:South Africa; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D055815:Young Adult
D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D016044:Fusion Proteins, bcr-abl
Chronic myeloid leukemia; Cytogenetic response; Hematological response; Molecular response; Tyrosine kinase inhibitors