title: The reality of cancer treatment in a developing country: the effects of delayed TKI treatment on survival, cytogenetic and molecular responses in chronic myeloid leukaemia patients.
abstract: Cancer patients in developing and low-income countries have limited access to target therapies. For example, tyrosine kinase inhibitor (TKI) therapy for chronic myeloid leukaemia patients (CML) is often delayed. In Bosnia, 16% of patients received immediate TKI treatment (<3 months of diagnosis), while 66% of patients received therapy after a median 14-month wait period. To assess the effect of delayed treatment on outcome, three patient groups were studied according to the time they received TKI treatment (0-5 months, 6-12 months and >13 months delay). The primary endpoints were complete cytogenetic (CCyR) and major molecular response (MMR) at 12 months. At 12 months of therapy, CCyR and MMR rates on imatinib decreased significantly: CCyR was achieved in 67% of patients in the immediate imatinib treatment group, 18% of patients in 6-12 months group and 15% of patients in >13 months wait group. MMR rates at 12 months occurred in 10% of patients with immediate treatment, 6% of those in 6-12 months group and 0% of patients in >13 months wait group. However, CCyR and MMR rates in patients on nilotinib were not associated with duration of treatment delay. Our data suggests that the deleterious effect of a prolonged TKI therapy delay may be ameliorated by the more active TKI nilotinib.
authors.affiliation: Department of Pathology, University Clinical Centre Sarajevo, Sarajevo, Bosnia and Herzegovina.|Department of Biology, Faculty of Natural Sciences, University of Sarajevo, Sarajevo, Bosnia and Herzegovina.|Department of Genetics and Bioengineering, International Burch University, Sarajevo, Bosnia and Herzegovina.
authors.forename: Amina
authors.initials: A
authors.lastname: Kurtovic-Kozaric
authors.affiliation: Department of Biology, Faculty of Natural Sciences, University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
authors.forename: Azra
authors.initials: A
authors.lastname: Hasic
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: Jerald P
authors.initials: JP
authors.lastname: Radich
authors.affiliation: Haematology Clinic, University Clinical Centre Sarajevo, Sarajevo, Bosnia and Herzegovina.
authors.forename: Vildan
authors.initials: V
authors.lastname: Bijedic
authors.affiliation: Department of Biology, Faculty of Natural Sciences, University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
authors.forename: Hilada
authors.initials: H
authors.lastname: Nefic
authors.affiliation: Department of Biology, Faculty of Natural Sciences, University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
authors.forename: Izet
authors.initials: I
authors.lastname: Eminovic
authors.affiliation: Haematology Clinic, University Clinical Centre Sarajevo, Sarajevo, Bosnia and Herzegovina.
authors.forename: Sabira
authors.initials: S
authors.lastname: Kurtovic
authors.affiliation: Haematology Clinic, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina.
authors.forename: Ferida
authors.initials: F
authors.lastname: Colakovic
authors.affiliation: Centre for Mother and Child, University Clinical Centre Sarajevo, Sarajevo, Bosnia and Herzegovina.|Department of Genetics and Bioengineering, International Burch University, Sarajevo, Bosnia and Herzegovina.
authors.forename: Mirza
authors.initials: M
authors.lastname: Kozaric
authors.affiliation: Department of Pathology, University Clinical Centre Sarajevo, Sarajevo, Bosnia and Herzegovina.
authors.forename: Semir
authors.initials: S
authors.lastname: Vranic
authors.affiliation: Department of Internal Medicine, Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina.
authors.forename: Nada S
authors.initials: NS
authors.lastname: Bovan
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D017522:Bosnia and Herzegovina; D003906:Developing Countries; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D016044:Fusion Proteins, bcr-abl / Q000235:genetics; D006801:Humans; D000068877:Imatinib Mesylate / Q000008:administration & dosage / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy* / Q000235:genetics*; D008297:Male; D008875:Middle Aged; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors; D011743:Pyrimidines / Q000008:administration & dosage / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; C581634:BCR-ABL1 fusion protein, human; D047428:Protein Kinase Inhibitors; D011743:Pyrimidines; D000068877:Imatinib Mesylate; D011505:Protein-Tyrosine Kinases; D016044:Fusion Proteins, bcr-abl; C498826:nilotinib
keywords: chronic myeloid leukaemia; cytogenetic response; molecular response; treatment delay