A retrospective analysis of clinicopathological features and treatment outcomes of patients with chronic myeloid leukemia at a tertiary hospital

Abstract

Introduction Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm that shows the characteristic formation of the Philadelphia chromosome, containing the BCR-ABL1 fusion gene. Objective The experience with patients with CML regarding clinical features, as well as efficacy and safety of tyrosine kinase inhibitors (TKIs) as a treatment for CML was analyzed in this study. Materials and methods A retrospective study was conducted in patients diagnosed with CML regarding clinicomorphological features and treatment outcome in a tertiary hospital located in southwest Saudi Arabia from July 2004 to June 2020. The study population included patients diagnosed with CML who were older than 12 years. Patients younger than 12 years, BCR-ABL-negative CML, and other myeloproliferative neoplasm were not included in the study. Medical records of patients were reviewed, and data were collected. Results During this period, 80 patients with CML were treated. The mean age was 41.6 years, with a slight male predominance. Overall, 90% of patients presented with abdominal discomfort and fatigue. Chronic phase represented 90% of all cases, with 55.5% showing intermediate-risk category of the Sokal score. Patients receiving a first-line treatment with first-generation TKI represented 42.5% and second-generation TKIs represented 52.5%. Complete hematological response was noted in 96.2% of patients after 3 months of treatment, and a major molecular response was seen in 77.2% of patients after 12 months of treatment. Adverse events (AEs) of TKI noted were 16 (20%), of which 81.2% were grade 1. They were as follows: pleural effusion in four (5%), neutropenia in two (2.5%), bone marrow suppression in four (5%), and skin itching in six (7.5%) in patients with dasatinib, contributing to 56.2% of all AEs. Overall, four (5%) patients were in treatment-free remission. Mean survival period in chronic phase CML was found to be 15.4 years, whereas in advanced phase CML was 4.7 years. Conclusion Our study revealed that patients with CML were predominantly middle aged with a slight male preponderance. Most patients presented in the chronic phase, with the Sokal score in the intermediate-risk category. Patients were treated upfront with TKIs with a significant number receiving second-generation TKIs. First-generation TKIs had lesser AEs as compared with second-generation TKIs, but these toxicities were mild.