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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.

Author information

1
Department of Pathology, University Clinical Centre Sarajevo, Sarajevo, Bosnia and Herzegovina.
2
Department of Biology, Faculty of Natural Sciences, University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
3
Department of Genetics and Bioengineering, International Burch University, Sarajevo, Bosnia and Herzegovina.
4
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
5
Haematology Clinic, University Clinical Centre Sarajevo, Sarajevo, Bosnia and Herzegovina.
6
Haematology Clinic, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina.
7
Centre for Mother and Child, University Clinical Centre Sarajevo, Sarajevo, Bosnia and Herzegovina.
8
Department of Internal Medicine, Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina.

Abstract

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.

KEYWORDS:

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

PMID:
26554639
DOI:
10.1111/bjh.13843
[Indexed for MEDLINE]

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