RESULT OF THE TREATMENT OF CHRONIC MYELOID LEUKEMIA WITH IMATINIB FROM THE VIETNAM NATIONAL INSTITUTE OF HEMATOLOGY AND BLOOD TRANSFUSION

Introduction. Chronic myeloid leukemia (CML) ranks third among hematological malignancies in Vietnam. Imatinib has become the standard therapy for CML patients in Vietnam since 2009.

Materials and methods. A phase IV clinical study for 1st line imatinib treatment of CML patients, carried out in 121 CML patients treated in NIHBT and receiving imatinib 400 mg/daily from 2010 to 2014.

Results. Cumulative CCyR and CMR were achieved in 82 (67.8%) and 80 (66.1%) of patients, respectively. There was a correlation between the time interval (from CML diagnosis to initiating imatinib treatment) and both complete cytogenetic (OR 0.158; p = 0.001) and molecular (OR 0.263; p = 0.018) responses. The analysis demonstrated that imatinib treatment minimized the prognostic impact of previously established prognostic factors in CML. The 3-year PFS and OS rates were 114 (94.6%) and 118 (97.5%), respectively. Hematologic adverse effects were mild with 1st and 2nd grades anemia, granulocytopenia and thrombocytopenia found in 17 (14%), 27 (22.3%) and 29 (23.9%) patients, respectively. The most commonly non-hematologic adverse effects occurred in 1st year of follow-up including periorbital edema, nausea, musculoskeletal pain, and rash.

1. Baccarani M, Deininger MW, Rosti G et al. European LeukemiaNet recommendations for the management of chronic myeloid leukemia 2013. Blood 2013; 122:872—884. doi: 10.1182/blood-2013-05-501569.

2. Tran Thi Minh Huong, Do Trung Phan. Epidemiology of hematopoietic diseases in northern Vietnam according to statistics data from Institute of Hematology and Blood Transfusion, Bach Mai hospital. Annu Hematol Sci Res 2002; 8:15—24.

3. Sokal JE, Cox EB, Baccarani M et al. Prognostic discrimination in “good-risk” chronic granulocytic leukemia. Blood 1984; 63:789—799.

4. Hughes TP, Hochhaus A, Branford S et al. Long-term prognostic significance of early molecular response to imatinib in newly diagnosed chronic myeloid leukemia: an analysis from the International Randomized Study of Interferon and STI571 (IRIS). Blood 2010; 116:3758—3765. doi: 10.1182/blood-2010-03-273979.

5. Hanfstein B, Muller MC, Hehlmann R et al. Early molecular and cytogenetic response is predictive for long-term progression-free and overall survival in chronic myeloid leukemia (CML). Leukemia 2012; 26:2096—2102. doi:10.1038/leu.2012.85.

6. Rousselot Ph, Guilhot J, Preudhomme C et al. Relationship between molecular responses and disease progression in patients treated first line with imatinib (Im) based regimens: impact of treatment arm within the French Spirit trial from the French CML group (FI LMC). Blood 2012; 120:168.

7. Chavan D, Ahmad F, Iyer P et al. Cytogenetic investigation in chronic myeloid leukemia: study from an Indian population. Asian Pac J Cancer Prev 2006; 7:423—426.

8. Irfan SM, Bhurgri Y. Clinico-pathological features and outcomes in chronic phase chronic myeloid leukemia patients treated with hydroxyurea. Asian Pac J Cancer Prev 2009; 10:591—594.

9. Bhat G, Bhat A, Wani A et al. Polymorphic variation in glutathione-S-transferase genes and risk of chronic myeloid leukaemia in the Kashmiri population. Asian Pac J Cancer 2012; 13:69—73.

10. Usmani SZ, Yunus SA, Jamal Y. Overview of chronic myeloid leukemia patients in Pakistan in the pre-imatanib era. Asian Pac J Cancer Prev 2009; 10:1039—1040.

11. Kantarjian H, O’Brien S, Jabbour E et al. Improved survival in chronic myeloid leukemia since the introduction of imatinib therapy: a single-institution historical experience. Blood 2012; 119:1981—1987. doi: 10.1182/blood-2011-08-358135

12. Payandeh M, Sadeghi M, Sadeghi E. Treatment and survival in patients with chronic myeloid leukemia in a chronic phase in West Iran. Asian Pac J Cancer Prev 2015; 16:7555—7559.

13. Branford S, Seymour JF, Grigg A et al. BCR-ABL messenger RNA levels continue to decline in patients with chronic phase chronic myeloid leukemia treated with imatinib for more than 5 years and approximately half of all first-line treated patients have stable undetectable BCR-ABL using strict sensitivity criteria. Clin Cancer Res 2007; 13:7080—7085. doi: 10.1158/1078-0432.CCR-07-0844.

14. Druker BJ, Guilhot F, O’Brien SG et al. Five-year follow-up of patients receiving imatinib for chronic myeloid leukemia. N Engl J Med 2006; 355:2408—2417. doi: 10.1056/NEJMoa062867.

15. Hochhaus A, O’Brien SG, Guilhot F et al. Six-year follow-up of patients receiving imatinib for the first-line treatment of chronic myeloid leukemia. Leukemia 2009; 23:1054—1061. doi:10.1038/leu.2009.38.

16. Kantarjian HM, O’Brien S, Cortes JE et al. Complete cytogenetic and molecular responses to interferon alpha-based therapy for chronic myelogenous leukemia are associated with excellent long-term prognosis. Cancer 2003; 97:1033—1041. doi: 10.1002/cncr.11223.

17. Hehlmann R, Lauseker M, Jung-Munkwitz S et al. Tolerability-adapted imatinib 800 mg/d versus 400 mg/d versus 400 mg/d plus interferon αin newly diagnosed chronic myeloid leukemia. J Clin Oncol 2011; 29:1634—1642. doi: 10.1200/JCO.2010.32.0598.

18. Payandeh M, Sadeghi E, Sadeghi M. Non-hematological adverse events of imatinib in patients with chronic myeloid leukemia in chronic phase (CML-CP). J App Pharm Sci 2015; 5:87—90. doi: 10.7324/JAPS.2015.50213.

19. Petzer AL, Eaves CJ, Lansdorp PM et al. Characterization of primitive subpopulations of normal and leukemic cells present in the blood of patients with newly diagnosed as well as established chronic myeloid leukemia. Blood 1996; 88:2162—2171.

20. Jabbour E, Deininger M, Hochhaus A. Management of adverse events associated with tyrosine kinase inhibitors in the treatment of chronic myeloid leukemia. Leukemia 2011; 25:201—210. doi:10.1038/leu.2010.215.