Background
Chronic Myeloid Leukemia (CML) is characterized by the accumulation of immature white blood cells due to the Philadelphia chromosome, producing the BCR-ABL1 oncogene. Targeted therapies like Imatinib, Dasatinib, Nilotinib, and Ponatinib inhibit BCR-ABL1 activity, transforming CML into a manageable condition with favorable outcomes. Introduced in 2003 at Patan Hospital, Imatinib was followed by newer Tyrosine kinase inhibitors(TKIs) including third-generation options, addressing treatment resistance and enhancing survival rates.
Methods
This retrospective study spans 20 years (March 2003 to April 2023) and investigates CML patients. Key focuses include the type and number of TKIs used, patient demographics, molecular response, resistance patterns, and treatment outcomes. Molecular analysis was conducted selectively based on patient affordability, with some opting for conventional cytogenetic exams due to cost.
Results
Out of 431 patients, the initial treatment started with about 99.1% on Imatinib. About 24.8% Patients switched to other 2nd and 3rd generation TKIs. Currently, 74.4% patients(N=431) are on Imatinib with a mortality of 4.7%. 15.5% on Dasatinib (mortality =22.4%), Ponatinib 6% (mortality=38.5%), Nilotinib 3.24%(mortality=14.3%), Bosutinib 0.7%. 213(46.4%) have achieved deep molecular response. About 79(23.2%) patients have achieved major molecular response and 50 (11.6%) patients have achieved early molecular response. The survival rate among CML patients was 89.1%.
Conclusions
Despite all the challenges faced by Nepal in terms of patient education, poor economic condition, communication delay, deficiency of labs for sample testing, the results of survival rate are remarkable. It is noteworthy that the response to Imatinib therapy in Nepalese patients mirrors the outcomes observed in meticulously conducted clinical trials. There is increasing resistance to Imatinib which necessitates tailored treatment strategies to optimize patient outcomes.