Chronic Myeloid Leukemia in Nigerian Patients: Anemia is an Independent Predictor of Overall Survival

Abstract

OBJECTIVESThe advent of the tyrosine kinase inhibitors has markedly changed the prognostic outlook for patients with Ph+ and/or BCR-ABL1+ chronic myeloid leukemia (CML). This study was designed to assess the overall survival (OS) of Nigerian patients with CML receiving imatinib therapy and to identify the significant predictors of OS.METHODSAll patients with CML receiving imatinib from July 2003 to June 2013 were studied. The clinical and hematological parameters were studied. The Kaplan–Meier technique was used to estimate the OS and median survival. P-value of <0.05 was considered as statistically significant.RESULTSThe median age of all 527 patients (male/female = 320/207) was 37 (range 10–87) years. There were 472, 47, and 7 in chronic phase (CP), accelerated phase, and blastic phase, respectively. As at June 2013, 442 patients are alive. The median survival was 105.7 months (95% confidence interval [CI], 91.5–119.9); while OS at one, two, and five years were 95%, 90%, and 75%, respectively. Multivariate Cox regression analysis revealed that OS was significantly better in patients diagnosed with CP (P = 0.001, odds ratio = 1.576, 95% CI = 1.205–2.061) or not in patients with anemia (P = 0.031, odds ratio = 1.666, 95% CI = 1.047–2.649). Combining these variables yielded three prognostic groups: CP without anemia, CP with anemia, and non-CP, with significantly different median OS of 123.3, 92.0, and 74.7 months, respectively (χ2 = 22.042, P = 0.000016).CONCLUSIONThis study has clearly shown that for Nigerian patients with CML, the clinical phase of the disease at diagnosis and the hematocrit can be used to stratify patients into low, intermediate, and high risk groups.

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“…Eighteen CML patients in chronic phase, 7 males (39%) & 11 females (61%) (Figure 1), mean age 41.8 years (24-55 years), ( Figure 2) shows the distribution of CML patients according to age groups. In male patients, 43% were in (30-39), 29% were in (50-59), 14% in (20)(21)(22)(23)(24)(25)(26)(27)(28)(29), and (40-49) years but in female patients, 55% were in (40-49), 18% in (30)(31)(32)(33)(34)(35)(36)(37)(38)(39), 9% in (20)(21)(22)(23)(24)(25)(26)(27)(28)(29), (50-59), and (60-69) years. Overall 18 cases, the hematologic response of 14 cases was complete WBCs decrease to normal range within 4 months) with P value of less than 0.0001 whereas in 4 cases WBCs were decreased slowly (after 8months).…”

“…Five of 18 patients developed cytopenias requiring treatment interruption and/or dose reduction, but all were able to continue incomplete hematologic responses on the study. Also, the study of Oyekunle et al, 29 , showed that the clinical phase of the disease at diagnosis and the hematocrit can be used to stratify patients into low, intermediate, and high risk groups, with significantly different survival outcomes in Nigerian patients with CML. Aissata et al, 17 , reported that CML patients were severely symptomatic with a performance status ≥2 in 100%, splenomegaly in 100%, fever in 74%, hepatomegaly in 48%, bone pains in 48% and lymphadenopathy in 22%.…”

“…It may also be a reflection of how patients' premorbid state may affect disease outcome, as many of these patients may have been anemic long before CML was diagnosed. 29 In the present study, the correlation between the treatment doses and variation in haematological parameters and PCR results were appeared as a significant positive correlation between the treatment doses and Hb, hematocrit, MCV, MCH, esinophils%, and monocytes %, and a significant negative correlation between the treatment doses and RDW %, Platelets Count, WBCs count, and Basophils%, but no correlation between the treatment doses and RBCs Count, MCHC, Neutrophils % and BCR/APL ratio % On the other hand, Abdalruhman 11 , reported that absolute lymphocyte count inversely correlated with the duration of treatment, but there is no statistically significant reduction of absolute lymphocyte count, that is similar to the data of Santachiara et al, 31 About the hematological indices; MCV and MCH are inversely correlated with duration of treatment with a picture of hypochromic microcytic red cells may be due to chronic illness.…”

Paediatric Chronic Myeloid Leukaemia in a Tertiary Hospital in Nigeria: A Report of Two Cases

“…Following two weeks of no appreciable clinical and haematological response with treatment on HU, he was referred to Obafemi Awolowo University Teaching Hospital (OAUTH) Ile-Ife where he was enrolled into Glivec International Patient Assistance Programme (GIPAP) [10] for imatinib therapy. This patient however was lost to follow up following this referral.…”

“…Over 90% of patients are diagnosed in CP [1,6]. The percentage of blast cells found in the bone marrow or peripheral blood film is used to categorize the phase of the disease, as well as the severity of the symptoms [10]. The blast phase of CML presents like the acute myeloid form in 60% of cases, and the lymphoid form in 30% of cases [6].…”