The outcomes of the imatinib melilat treatment in Chronic Myeloid Leukemia patients and the assasment of patient follow ups

Background and objective: in chronic myeloid leukemia (CML) treatment, the treatment options were reducing the number of leukocyte (such as busulfan, hydroxyurea), nonspecific suppression of Philadelphia (Ph) positive cells, interferon-alpha (IFN-?), IFN-? + cytarabine and allogeneic hematopoietic cell transplantation (AHCT) until five years ago. Today with the introduction of imatinib mesilat (IM-STI571), it has been the first line treatment option in CML treatment. Better hematologic, cytogenetic and molecular responses are obtained and better mean survival and non progressive survival are possible with IM treatment. In our study with 84 CML cases followed up in Dokuz Eylül University Faculty of Medicine and İzmir Atatürk Training and Research Hospital, The Clinic of Hematology and treated with IM, we assessed whether the patients were followed up according to the guidelines or not with hematologic, cytogenetic and molecular responses.Material and method: 84 Ph (+) CML cases followed up between January 1999 and March 2010 in Dokuz Eylül University Faculty of Medicine and İzmir Atatürk Training and Research Hospitals were included in the study. The hematologic, cytogenetic and molecular responses of the patients receiving standard 400 mg/day imatinib mesilat treatment were evaluated.Findings: 44 (52.4%) of the patients were female and 40 (47.6%) were male. Their age was between 22 and 83, the mean age was 52.98 (±14.8) years and the median age was found to be 54.5. Mean follow-up period was 47.4 months and 80 patients (95.2%) were in chronic phase and 4 patients were in accelerated phase (4.8%).Hematologic response was obtained in 2.42 months in average. Complete hematologic response (CHR) was determined as 88.1% in the third month. The CHR was 90.8% in the sixth month, 93% in the twelfth month and 96.9% in the eighteenth month. In the 12th month, the cytogenetic of the patient was checked (67.9%). Complete cytogenetic response (CCR) was obtained in 75.4% of them, in three patients there was a partial cytogenetic response (5.3%), in three patients minor cytogenetic response (MCR) (5.3%), in one patient minimal cytogenetic response (1.8%) was obtained. In four patients no cytogenetic response was received (7.0%). In three patients the sample was poor (5.3%). In the 18th month, 38 of the patients were checked for molecular response (45.2%). In 24 of these patients there was complete molecular response (63.2%), major molecular response was obtained in 10 patients (26.3%) and in four patients no molecular response was obtained (10,5%).During IM usage, in 22 patients degree 3-4, hematologic side effects were developed (26.2%), 12 patients developed rash (14.3%), periorbital edema was seen in 10 patients (11.9%), nausea in 10 patients (11.9%), in nine patients myalgia-arthralgia (10.7%), diarrhea in six patients (7.1%), stomach pain in four patients (4.8%), renal failure in three patients (3.6%), hepatic dysfunction in one patient (1.2%) and one patient developed CCF (1.2%). One patient under IM treatment switched to accelerated phase and one patient to blastic phase. Drugs were changed in three patients because of side effects, nine patients because of drug resistance and one patient because of side effects and drug resistance (15.5%). Four patients received Dasanitib, eight patients received Nilonitib and one patient received first Nilonitib then switched to Dasanitib treatment because of resistance. Mean survival periods of the patients were found to be 48.54 months (3-132 months), the period until the treatment failure was 30.67 months (9-61 months) in average.Conclusion: In chronic phase CML, imatinib mesilat is still tolerable and has been the first line option as an effective treatment. Including the new tyrosine kinase inhibitors, further research is required for more effective and curative treatment and standardization studies should be performed in the laboratory methods in patient follow-ups especially in the evaluation of molecular response.Key words: CML, İmatinib mesilat, Ph chromosome