title: Treating Philadelphia chromosome/BCR-ABL1 positive patients with Glivec (Imatinib mesylate): 10 years' experience at Patan Hospital, Nepal.
abstract: 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.
authors.affiliation: Patan Academy of Health Science, Kathmandu, Nepal.|Patan Hospital, Kathmandu, Nepal.
authors.forename: Gyan K
authors.initials: GK
authors.lastname: Kayastha
authors.affiliation: Patan Academy of Health Science, Kathmandu, Nepal.|Patan Hospital, Kathmandu, Nepal.
authors.forename: Nora
authors.initials: N
authors.lastname: Ranjitkar
authors.affiliation: Patan Academy of Health Science, Kathmandu, Nepal.|Patan Hospital, Kathmandu, Nepal.
authors.forename: Radha
authors.initials: R
authors.lastname: Gurung
authors.affiliation: Patan Academy of Health Science, Kathmandu, Nepal.|Patan Hospital, Kathmandu, Nepal.
authors.forename: Raj K
authors.initials: RK
authors.lastname: Kc
authors.affiliation: Patan Academy of Health Science, Kathmandu, Nepal.|Patan Hospital, Kathmandu, Nepal.
authors.forename: Sanjit
authors.initials: S
authors.lastname: Karki
authors.affiliation: Patan Academy of Health Science, Kathmandu, Nepal.|Patan Hospital, Kathmandu, Nepal.
authors.forename: Roshan
authors.initials: R
authors.lastname: Shrestha
authors.affiliation: Patan Academy of Health Science, Kathmandu, Nepal.|Patan Hospital, Kathmandu, Nepal.
authors.forename: Raj K
authors.initials: RK
authors.lastname: Thapa
authors.affiliation: Patan Academy of Health Science, Kathmandu, Nepal.|Patan Hospital, Kathmandu, Nepal.
authors.forename: Piyush
authors.initials: P
authors.lastname: Rajbhandari
authors.affiliation: Patan Academy of Health Science, Kathmandu, Nepal.|Patan Hospital, Kathmandu, Nepal.
authors.forename: Buddhi
authors.initials: B
authors.lastname: Poudyal
authors.affiliation: Patan Academy of Health Science, Kathmandu, Nepal.|Patan Hospital, Kathmandu, Nepal.
authors.forename: Paras
authors.initials: P
authors.lastname: Acharya
authors.affiliation: National Health Service Blood and Transplant and Radcliffe Department of Medicine, John Radcliffe Hospital, Oxford, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Roberts
authors.affiliation: Patan Academy of Health Science, Kathmandu, Nepal.|Patan Hospital, Kathmandu, Nepal.
authors.forename: Bruce
authors.initials: B
authors.lastname: Hayes
authors.affiliation: Patan Academy of Health Science, Kathmandu, Nepal.|Patan Hospital, Kathmandu, Nepal.
authors.forename: Mark
authors.initials: M
authors.lastname: Zimmerman
authors.affiliation: Patan Academy of Health Science, Kathmandu, Nepal.|Patan Hospital, Kathmandu, Nepal.|Oxford University Clinical Research Unit-Nepal, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
authors.forename: Buddha
authors.identifier: 0000-0002-1125-2743
authors.initials: B
authors.lastname: Basnyat
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.|Department of Oncology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Mansfield
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002648:Child; D005500:Follow-Up Studies; D006801:Humans; D000068877:Imatinib Mesylate / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy* / Q000235:genetics; D008507:Medically Underserved Area; D008875:Middle Aged; D009390:Nepal; D020133:Reverse Transcriptase Polymerase Chain Reaction / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D000068877:Imatinib Mesylate
keywords: 
  BCR-ABL1
  ; Glivec (Imatinib mesylate); Philadelphia chromosome