A Single Center Study of Prescribing and Treatment Outcomes of Patients with Chronic Myeloid Leukemia

Ladan Nekoohesh; Mohammad  H. Ghahremani1; Shahrbano  Rostami; Mohsen Nikbakht; Leila Nekoohesh; Roozbeh Naemi; Saeed  Mohammadi; Laya Ghadyaninejad; Seyed Asadollah Mousavi; Mohammad   Vaezi; Kamran Alimoghaddam; Bahram Chahardouli

doi:10.18502/ijhoscr.v14i1.2324

Ladan Nekoohesh
Mohammad H. Ghahremani1
Shahrbano Rostami
Mohsen Nikbakht
Leila Nekoohesh
Roozbeh Naemi
Saeed Mohammadi
Laya Ghadyaninejad
Seyed Asadollah Mousavi
Mohammad Vaezi
Kamran Alimoghaddam
Bahram Chahardouli

DOI: https://doi.org/10.18502/ijhoscr.v14i1.2324

Keywords: Chronic myeloid leukemia; Imatinib; Resistance

Abstract

Background: The present study investigated the patients with Chronic Myeloid Leukemia in chronic phase (CP-CML) who had been on the first- line Imatinib Mesylate (IM) therapy for a period of 84 months.

Materials and Methods: This retrospective study was conducted in 295 newly-diagnosed CP-CML patients(age >18 years) who were admitted to the Hematology, Oncology and Stem Cell Transplantation Research Center, Shariati Hospital, Tehran during 1 January, 2009 to 30 December, 2016. Response to treatment was evaluated by molecular response assessment. Rates of IM dose adjustment, switching to another drug therapy, progression to Accelerate Phase (AP) and Blastic Crisis (BC) and long-term outcomes included Overall Survival (OS) and Progression Free Survival (PFS) were assesed.

Results: Patients’ average age was 41.7 years, and 52.9% were male. 44.4% of patients at the month 18 achieved Major Molecular Response (MMR). Progression to AP/BC occurred in 26 patients during 84 months, and the estimated rate of OS and PFS were 71.83 and 74.48, respectively. Among the patients who did not achieve MMR at month 18 , 61 patients were treated with IM ( 400 mg /day), and then after month 18, 24(39.3%) of whom achieved MMR. Dose adjustments occurred in 60 patients (20.33%). IM dose increase was observed in 53 patients who did not achive optimal response to imatinib or loss of optimal response. IM dose decrease was observed in 7 patients. 25 (8.47%) patients were switched to a different Tyrosine Kinase Inhibitor (TKI). Most of TKI changes(n=21) happened in patients who did not achieve optimal response to IM and TKI changes owing to adverse events of IM were observed in 4 patients.. Among the patients undergoing change in treatment, 24(43.75%) patients achieved MMR.

Conclusion: Our data showed the high effectiveness of the change in the treatment of IM-resistant condition. Moreover, our finding suggests that imatinib be effective in Iranian patients after a long period of time compared to the referenced studies.