title: Diagnosis and Treatment of Chronic Myeloid Leukemia in the Imatinib Mesylate Era: Report of the Experience at "La Raza" Medical Center in Mexico.
abstract: BACKGROUND
  With the advent of tyrosine kinase inhibitors (TKIs), the prognosis of chronic myeloid leukemia (CML) has undergone significant changes in all age groups and at different clinical stages over the past 15 years. Consequently, although disease incidence has remained stable, cumulative prevalence is increasing.
  
  
  METHODS
  We reviewed our experience with imatinib mesylate (IM) as a first- and second-line treatment for different CML stages to examine demographic and clinical characteristics of patients, cytogenetic and molecular response rates, as well as overall survival (OS), progression-free survival, and event-free survival of patients at the Specialties Hospital of the National Medical Center "La Raza," which belongs to the Mexican Social Security Institute and serves a population with medium to low socioeconomic status.
  
  
  RESULTS
  We analyzed data of 302 CML patients who received IM as a first- (n = 234) or second-line treatment (n = 68). Overall, 198 of 302 patients (66%) reached a complete cytogenetic response and at least 115 of 302 (38%) achieved a major molecular response. Among 302 IM-treated patients, 55 (18%) achieved a molecular response 4.5 (MR4.5) or major; at the time of writing this report, 283 (93.7%) were alive and 19 (6.29%) had died. At 60 months, OS was 94%.
  
  
  CONCLUSIONS
  IM offers long-term OS expectations not previously observed with any other therapy, in addition to a good quality of life. However, more than a third of the patients require further treatment with a second-generation TKI; consequently, expectations for treatment-free remission and long-term OS are reduced. Timely change to second-generation TKIs could improve such expectations.
authors.affiliation: Departamento de Hematología y Unidad de Trasplante de Células Progenitoras Hematopoyéticas, Hospital de Especialidades del Centro Médico Nacional "La Raza" IMSS, México City, México. Electronic address: joseluaya@gmail.com.
authors.forename: Manuel
authors.initials: M
authors.lastname: Ayala
authors.affiliation: Departamento de Hematología y Unidad de Trasplante de Células Progenitoras Hematopoyéticas, Hospital de Especialidades del Centro Médico Nacional "La Raza" IMSS, México City, México.
authors.forename: Elsa
authors.initials: E
authors.lastname: Ávila
authors.affiliation: Grupo Consulmed del Hospital de Especialidades del Centro Médico Nacional "La Raza" IMSS, México City, México.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Domínguez
authors.affiliation: Grupo Consulmed del Hospital de Especialidades del Centro Médico Nacional "La Raza" IMSS, México City, México.
authors.forename: Xóchitl
authors.initials: X
authors.lastname: Aquino
authors.affiliation: Departamento de Hematología y Unidad de Trasplante de Células Progenitoras Hematopoyéticas, Hospital de Especialidades del Centro Médico Nacional "La Raza" IMSS, México City, México.
authors.forename: Jorge
authors.initials: J
authors.lastname: Vela
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D000068877:Imatinib Mesylate / Q000627:therapeutic use*; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy*; D008297:Male; D008800:Mexico; D008875:Middle Aged; D011379:Prognosis; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D011788:Quality of Life; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D047428:Protein Kinase Inhibitors; D000068877:Imatinib Mesylate
keywords: Chronic myeloid leukemia; First line; Polymerase chain reaction; Treatment; Tyrosine kinase inhibitors