Early molecular response in East African Philadelphia chromosome-positive chronic myeloid leukaemia patients treated with Imatinib and barriers to access treatment.

Oliver Henke,Priscus John Mapendo,Philipp le Coutre,Elifuraha Wilson Mkwizu

doi:10.3332/ecancer.2020.1089

Abstract

BackgroundData about haematologic malignancies from Tanzania are sparse. African studies show that chronic myeloid leukaemia (CML) is the most common leukaemia, and registry data display a lower mean age at diagnosis. Prognosis is generally good with tyrosine kinase inhibitors, but the molecular response of Imatinib treatment has never been studied in East Africa, and the outcome remains unknown. This study assessed the early molecular response (MR) as a predictor for long-term outcome and barriers to access treatment.MethodsA case series of patients with CML from Northern Tanzania documented demographics and laboratory and clinical findings at diagnosis and after 3 months. The regression analysis has been performed on early MR and clinical and demographic variables using the χ2-test. The barriers of potential treatments have been assessed.ResultsA total of 30 patients have been analysed. The mean age was 41 years. All patients had splenomegaly, whereas 16 had hepatomegaly. Complete haematologic response was achieved in 16 and early MR in 9 patients. Hepatomegaly was positively correlated with unfavourable early MR. The average kilometre from home to hospital was 282 km (5–1,158 km). Travel expenses and time investments pose an impediment to treatment.ConclusionPatients are younger, and early MR rates are lower compared to other studies. The finding of hepatomegaly as a risk factor for unfavourable early MR was described previously in West Africa. Adherence to therapy is high in the first months of treatment. Furthermore, research is needed to understand the poor MR and the common presentation of hepatomegaly. Outreach clinics might be a solution to reduce impediments to treatment.

Highlights

According to the Global Cancer Statistics, cancer becomes more of a global public health issue in low- and middle-income countries (LMICs)[1], due to multiple factors, e.g., increased life expectancy leading to the reduction of other causes of death, in addition to advances in diagnostic measurements and detection practices which contribute to higher cancer incidence [2].For Tanzania, it is estimated that the cancer incidence will double by the year 2030, from 37,000 new cases in 2015 to more than 61,000 cases [3].Global incidence of Chronic Myeloid LeukaemiaThe crude annual incidence of chronic myeloid leukaemia (CML) in Europe ranges between 0.7 and 1.0/100,000 with a median age at a diagnosis of 57–60 years [6]
African studies show that chronic myeloid leukaemia (CML) is the most common leukaemia, and registry data display a lower mean age at diagnosis
Prognosis is generally good with tyrosine kinase inhibitors, but the molecular response of Imatinib treatment has never been studied in East Africa, and the outcome remains unknown

Summary

Introduction

According to the Global Cancer Statistics, cancer becomes more of a global public health issue in low- and middle-income countries (LMICs)[1], due to multiple factors, e.g., increased life expectancy leading to the reduction of other causes of death, in addition to advances in diagnostic measurements and detection practices which contribute to higher cancer incidence [2].For Tanzania, it is estimated that the cancer incidence will double by the year 2030, from 37,000 new cases in 2015 to more than 61,000 cases [3].Global incidence of Chronic Myeloid LeukaemiaThe crude annual incidence of CML in Europe ranges between 0.7 and 1.0/100,000 with a median age at a diagnosis of 57–60 years [6]. A study from Sudan states that CML is the most common type of leukaemia in this country in patients with an age group of 16 years and above, whereas ‘leukaemia’ as a group of diseases is the second most common cancer entity in the country [8]. A retrospective data analysis from Ethiopia came to the same conclusion, as CML was the most common leukaemia entity amongst 67 cases of haematologic malignancies at a single centre [9]. African studies show that chronic myeloid leukaemia (CML) is the most common leukaemia, and registry data display a lower mean age at diagnosis.

Results

Discussion

Conclusion