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Br J Haematol. 2016 Feb;172(3):420-7. doi: 10.1111/bjh.13843. Epub 2015 Nov 11.

The reality of cancer treatment in a developing country: the effects of delayed TKI treatment on survival, cytogenetic and molecular responses in chronic myeloid leukaemia patients.

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Department of Pathology, University Clinical Centre Sarajevo, Sarajevo, Bosnia and Herzegovina.
Department of Biology, Faculty of Natural Sciences, University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
Department of Genetics and Bioengineering, International Burch University, Sarajevo, Bosnia and Herzegovina.
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Haematology Clinic, University Clinical Centre Sarajevo, Sarajevo, Bosnia and Herzegovina.
Haematology Clinic, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina.
Centre for Mother and Child, University Clinical Centre Sarajevo, Sarajevo, Bosnia and Herzegovina.
Department of Internal Medicine, Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina.


Cancer patients in developing and low-income countries have limited access to target therapies. For example, tyrosine kinase inhibitor (TKI) therapy for chronic myeloid leukaemia patients (CML) is often delayed. In Bosnia, 16% of patients received immediate TKI treatment (<3 months of diagnosis), while 66% of patients received therapy after a median 14-month wait period. To assess the effect of delayed treatment on outcome, three patient groups were studied according to the time they received TKI treatment (0-5 months, 6-12 months and >13 months delay). The primary endpoints were complete cytogenetic (CCyR) and major molecular response (MMR) at 12 months. At 12 months of therapy, CCyR and MMR rates on imatinib decreased significantly: CCyR was achieved in 67% of patients in the immediate imatinib treatment group, 18% of patients in 6-12 months group and 15% of patients in >13 months wait group. MMR rates at 12 months occurred in 10% of patients with immediate treatment, 6% of those in 6-12 months group and 0% of patients in >13 months wait group. However, CCyR and MMR rates in patients on nilotinib were not associated with duration of treatment delay. Our data suggests that the deleterious effect of a prolonged TKI therapy delay may be ameliorated by the more active TKI nilotinib.


chronic myeloid leukaemia; cytogenetic response; molecular response; treatment delay

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