157: Therapeutic Choices in Patients with Ph1 (+) Chronic Myelogenous Leukemia Living in Developing Countries in the Tyrosine Kinase Inhibitors (TKI) Era: Stem Cell Transplantation or TKI?

Ruíz‐Argüelles, Guillermo J.; Tarín‐Arzaga, Luz; González-Carrillo, Martha L.; Gutiérrez-Riveroll, Karla Itzel; Rangel-Malo, R; Gutiérrez-Aguirre, César Homero; Cantú-Rodrı́guez, Olga Graciela; Gomez-Almaguer, D.; Giralt, Sergio

doi:10.1016/j.bbmt.2007.12.166

Cited by 7 publications

(7 citation statements)

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“…In many cases in Mexico, decisions on whether to offer TKI or BMT treatment to CML patients depend on economic conditions, access to public or private health services, and stable employment. 19 The trend to reduce BMT in patients with CML observed in developed countries is not seen in Mexico owing to the previously described causes; a similar trend is observed in Latin American and other developing countries. The "Mexican method" for bone marrow transplant in patients with leukemia has been implemented in other countries with unfavorable economies, such as ours, and has shown similar outcomes.…”

Section: Chronic Myeloid Leukemia (Cml)mentioning

confidence: 59%

“…The "Mexican method" for bone marrow transplant in patients with leukemia has been implemented in other countries with unfavorable economies, such as ours, and has shown similar outcomes. 18,19 The availability of molecular biology methods for the diagnosis and follow-up of patients with this neoplasm has considerably improved its prognosis. 16 Compared with other leukemias, CML has shown the most improved prognosis during the last decade due to the availability of molecular treatment and BMT implementation.…”

Section: Chronic Myeloid Leukemia (Cml)mentioning

confidence: 99%

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Advances in the diagnosis and treatment of acute and chronic leukemia in Mexico

Ruíz‐Argüelles

2016

Salud Publica Mex

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Section: Chronic Myeloid Leukemia (Cml)mentioning

confidence: 59%

Section: Chronic Myeloid Leukemia (Cml)mentioning

confidence: 99%

Advances in the diagnosis and treatment of acute and chronic leukemia in Mexico

Ruíz‐Argüelles

2016

Salud Publica Mex

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“…We have been particularly interested in the analysis of the cost-benefit aspects of the treatment of haematological diseases in México. Along this line, we have shown that stem cell transplantation, employing our 'Mexican approach', has a better costbenefit ratio than treatment with novel drugs in chronic myelogenous leukaemia 23,24 and in multiple myeloma. 23,25 Since the median cost of a stem cell allograft in our experience is 20 000 USD in the first 100 days, [18][19][20]23,24 and the estimated price of the treatment of PNH with eculizumab is around 400 000 USD per year per patient, 5,11 we can state that 20 patients with PNH could be allografted in our country with the amount of money employed in the treatment of a single patient for 1 year.…”

Section: Discussionmentioning

confidence: 96%

Reduced-intensity stem cell allografting for PNH patients in the eculizumab era: The Mexican experience

et al. 2014

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Background Paroxysmal nocturnal haemoglobinuria (PNH) presents as two major entities: the classical form, predominantly haemolytic and a secondary type with marrow failure and resultant aplastic anaemia (AA-PNH). Currently, the treatment of choice of the haemolytic variant is eculizumab; however, the most frequent form of PNH in México is AA-PNH. Patients and methods Six consecutive AA-PNH patients with HLA-identical siblings were allografted in two institutions in México, employing a reduced-intensity conditioning regimen for stem cell transplantation (RIST) conducted on an outpatient basis. Results Median age of the patients was 37 years (range 25-48). The patients were given a median of 5.4 × 10(6)/kg allogeneic CD34(+) cells, using 1-3 apheresis procedures. Median time to achieve above 0.5 × 10(9)/l granulocytes was 21 days, whereas median time to achieve above 20 × 10(9)/l platelets was 17 days. Five patients are alive for 330-3150 days (median 1437) after the allograft. The 3150-day overall survival is 83.3%, whereas median survival has not been reached, being above 3150 days. Conclusion We have shown that hypoplastic PNH patients can be allografted safely using RIST and that the long-term results are adequate, the cost-benefit ratio of this treatment being reasonable. Additional studies are needed to confirm the usefulness of RIST in the treatment of AA-PNH.

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“…Recently, we have shown that, despite the fact that drug treatment is superior to allografting as first-line therapy in chronic myeloid leukemia in developed countries, allografting has still a relevant role in circumstances of limited resources, present in over 50% of the inhabitants of the world, where economic considerations can not be overlooked; cost considerations in this scenario may favor allo-SCT as a one-in-a-life-time procedure in which lifelong drug treatment with an expensive drug represents an excessive burden on resources. While allografting initial cost may be higher both to the society and the individual, it may still have a better lifetime economic value [67,68].…”

Section: Resultsmentioning

confidence: 99%

“…Despite the fact that most studies with reduced intensity conditioning have a relatively short follow up, there is information which indicates that the procedure is related with lower toxicities and a lower prevalence and severity of GVHD [61,63], with a similar efficacy as that of conventional allografting. Since this method is more feasible and affordable for patients and physicians in developing countries, the number of allografts in Latin America has increased substantially, as well as the publications related to bone marrow transplantation stemming from places where this therapeutic maneuver was considered as unaffordable previous to the development of this technology [64,67].…”

Section: Discussionmentioning

confidence: 99%

Making Allogeneic Bone Marrow Transplantation Available to Patients in Developing Countries: The Mexican Experience

Ruíz‐Argüelles¹,

Gómez‐Almaguer²

2008

TOHJ

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Non-myeloablative allogeneic stem cell transplantation (NST) has been one of the most exciting developments in the treatment of hematologic malignancies in the last years. Since 1999, we have chosen to employ in México a regimen to conduct NST, introducing some changes with the main goal of decreasing the cost of the procedure and in turn, making it available to a larger number of patients in developing countries. Using this method we have done over 400 allografts in Latin American patients with different both malignant and non-malignant diseases: Chronic myelogenous leukemia, acute myelogenous leukemia, acute lymphoblastic leukemia, myelodysplasia, thalassemia major, relapsed Hodgkin´s disease, Blackfan-Diamond syndrome, adrenoleukodystrophy, Hunter´s syndrome, aplastic anemia and several solid tumors. In the whole group, the median granulocyte recovery time to 0.5 x 10 9 /L was 13 days, whereas the median platelet recovery time to 20 x 10 9 /L was 12 days. Around one third of the patients did not need red blood cell transfusions and also one third did not need platelet transfusions. In more than 70% of cases the procedure could be completed totally on an outpatient basis. The follow up time of the patients ranges between 30 and 2000 days. Approximately 50% of the allografted individuals have developed acute graft versus host disease (GVHD), whereas around 30% developed chronic GVHD. The median post-allograft overall survival (SV) has not been reached and the 2000 day overall SV is 54%, the 100-day mortality being 16%. In the whole group of patients, the median cost of each NST was 18 000 USD, a figure which contrasts with that informed from developing countries. More than 95% of the patients who were allografted in México and Latin America using this method could not have afforded the cost of a conventional or more expensive stem cell transplant; accordingly, this procedure has enabled doctors in México and Latin America to offer this therapeutic approach to a larger number of individuals.

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157: Therapeutic Choices in Patients with Ph1 (+) Chronic Myelogenous Leukemia Living in Developing Countries in the Tyrosine Kinase Inhibitors (TKI) Era: Stem Cell Transplantation or TKI?

Cited by 7 publications

References 0 publications

Advances in the diagnosis and treatment of acute and chronic leukemia in Mexico

Advances in the diagnosis and treatment of acute and chronic leukemia in Mexico

Reduced-intensity stem cell allografting for PNH patients in the eculizumab era: The Mexican experience

Making Allogeneic Bone Marrow Transplantation Available to Patients in Developing Countries: The Mexican Experience

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