Treatment of Chronic Myeloid Leukemia in Rural Rwanda: Promising Early Outcomes

Abstract

PurposeThe burden of cancer is rising in low- and middle-income countries, yet cancer treatment requires resources that are often not available in these settings. Although management of chronic myeloid leukemia (CML) has been described in low- and middle-income countries, few programs involve patients treated in rural settings. We describe characteristics and early outcomes of patients treated for CML at rural district hospitals in Rwanda.MethodsWe conducted a retrospective review of patients with confirmed BCR-ABL–positive CML who were enrolled between July 1, 2009 and June 30, 2014. Types of data included patient demographics, diagnostic work up, treatment, clinical examination, laboratory testing, and death.ResultsForty-three patients were included, with a maximum follow-up of 58 months. Of 31 patients who were imatinib-naïve at enrollment, 54.8% were men and the median age at diagnosis was 36.9 years (interquartile range: 29-42 years). Approximately two-thirds of patients (67.7%) were on the national public insurance scheme. The imatinib dose was reduced for 16 patients and discontinued for five. Thirty-two of the 43 patients continued to have normal blood counts at last follow-up. Four patients have died and four are lost to follow-up.ConclusionOur experience indicates that CML can be effectively managed in a resource-constrained rural setting, despite limited availability of on-site diagnostic resources or specialty oncology personnel. The importance of model public-private partnerships as a strategy to bring high-cost, life-saving treatment to people who do not have the ability to pay is also highlighted.

Integration of Chronic Oncology Services in Noncommunicable Disease Clinic in Rural Rwanda

“…Lastly, outpatient oncology services in most rural settings require a high volume of referrals to higher levels of care for routine pathology, staging, chemotherapy, radiotherapy, and surgery. The BCCOE in the rural northern province of Rwanda has been well-documented as an exception given its broader spectrum of chemotherapy, pathology, and surgery services being readily available onsite at district hospital [10,22,24]. Outpatient oncology services in Rwinkwavu are ongoing, and the RMoH is exploring its applicability to other district hospitals in the country.…”

“…The limited study window and restriction to newly diagnosed cases at only one site left us with a small sample size for many of our reported conditions. Additionally, we do not report extensive disease-specific outcomes, but this information has been published elsewhere for several of the disease groups in combination with the cohort from Butaro Cancer Center of Excellence [22,[25][26][27][28][29][30][31]. An additional limitation of our study is that transfer data was not available in the EMR, so transferred patients may have been recorded as LTFU.…”

A Ten-Year Experience of Treating Chronic Myeloid Leukemia in Rural Rwanda: Outcomes and Insights for a Changing Landscape

“…[10][11][12][13][14] In Rwanda, a CML care delivery program was developed at two rural public hospitals, Rwinkwavu and Butaro Hospitals, in 2009 through collaboration between GIPAP, the Rwanda Ministry of Health (RMOH), the organization Partners In Health (PIH), and advisors from Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC). 15,16 Initially, in-country diagnostic testing was unavailable, and blood and bone marrow specimens were shipped to DF/BWCC for diagnostic confirmation of CML. Imatinib was then initiated in patients with confirmed CML.…”

Seroprevalence of Toxoplasma gondii Immunoglobulin G and Immunoglobulin M Antibodies among Leukemia Patients in Erbil City-Kurdistan Region/Iraq by Enzyme-linked Immunosorbent Assay Technique

“…Acute lymphocytic leukemia (ALL) is a malignancy that begins from the early form of white blood cells called lymphocytes in the bone marrow (Bala et al, 2016) while acute myeloid leukemia (AML) is a blood cancer which characterized by the infiltration of proliferative, clonal and abnormally differentiated cells of the hematopoietic system it comes as a consequence of arrested myeloid differentiation (Dohner et al, 2015;Aziz et al, 2017). While chronic myeloid leukemia described as a hematologic malignancy that can affect patients of all ages (Tapela et al, 2016).…”