Jahnvi Dhar
Maulana Azad Medical College and associated Lok Nayak Hospital, India
Title: Prospective Analysis Of Newly Diagnosed, Treatment Naïve Patients Of Chronic Myeloid Leukemia Over 2 Years In A Developing Country – A Comparison With Developed Countries
Biography
Biography: Jahnvi Dhar
Abstract
Background: CML is the most common adult leukemia in India, accounting for 50-70% of all leukemias in our country. The median age of presentation in India is 40-50 years which is a decade younger compared to the age of presentation in the western countries, which is around 66 years. The introduction of Tyrosine Kinase inhibitors (TKIs) mostly Imatinib mesylate has greatly enhanced survival from <30% to 85% in developing countries.
Aims and Objectives: This study was undertaken to analyze the newly diagnosed, treatment naïve CML patients based on the symptomology, hematological, clinic-pathological and cytogenetic analysis at the time of diagnosis and to compare these parameters post 6 weeks of chemotherapy (Imatinib). A comparison of the data obtained was done with data of the western world to analyze any differences.
Methods: 33 newly diagnosed CML patients (>18 years) were recruited from January 2015 to January 2017. Every patient underwent a complete set of hematological, radiological and cytogenetic analysis at the time of diagnosis. The patients were started on Imatinib Mesylate. The patients underwent an analysis of the hematological parameters after 6 weeks of chemotherapy to assess for Hematological remission (HR). Outcome of the patients was also noted.
Results: Total 33 newly diagnosed treatment naïve CML patients were recruited in 2 years. The range of age distribution was between 18-50 years. 23 (69.69%) of them were in the age group of 18-40 years. There were 20 (60%) males and 13(40%) females.
11 (34%) patients had presented with a duration of 3-4 months. The most symptom of the patients at the time of diagnosis was fatigue (88%) which was followed by pain/discomfort in the left hypochondrium (79%) and unexplained weight loss (64%).
On examination, pallor was present in all 33 (100%) patients and hepatomegaly and splenomegaly was noted in all the cases (100%). On ultrasound, the average size of the liver was around 15.47 ± 1.66 cm and the average size of the spleen was 19.80 ± 2.48 cm. HIV status was negative in 32 (97%) patients.
All the cases underwent a complete blood analysis at the time of diagnosis. Total leucocyte count (TLC in lacs) was significantly raised to the value of 319537+180886. Basophils accounted for 4.51+2.76%, myelocytes for 16.85+10.31% and blasts for 9.81+11.39% of the TLC. LDH (IU/L) and uric acid (mg/dl) were raised significantly to a value of 1567+541.4 and 10.67+6.83, respectively. L.A.P. score was reduced to a value of 7.54+1.88. Bone marrow aspirate and biopsy was done in all patients of CML. 22 (67%) patients were in the chronic phase, 7 (21%) in the accelerated phase and 4 (12%) were in blast crisis. Four cases had presented in Tumour lysis syndrome out of which one was in chronic phase, one in accelerated and 2 in blast crisis. BCR-ABL Mutation was positive in 32 (97%) patients.
Follow up of all the 33 patients was done after starting them on chemotherapy (Imatinib). Two of them died. Hence, 31 cases underwent a complete blood analysis after 6 weeks of chemotherapy. All the parameters were analysed along with hematological remission. 4 cases had presented in tumour lysis syndrome, in which one died (in blast crisis) and the remaining 3 did not achieve hematological remission (HR).
Majority of the parameters showed significant improvement after chemotherapy (p value <0.0001). TLC (lakhs) showed marked improvement from 319537+180886 to 8965+4373 (p value <0.0001), basophils (%) from 4.51+2.76 to 0.87+0.99 (p value <0.0001), myelocytes (%) decreased from 16.85+10.31 to 0.41+1.40 (p value <0.0001) and blasts (%) showed marked improvement from 9.81+11.39 to 0.61+2.04 (p value <0.0001).
Out of 33 cases, 2 (6%) had died. In the remaining 31 cases, hematological remission was assessed after 6 weeks of Imatinib mesylate. 27 (87%) out of 31 patients achieved HR and 4 (13%) did not. Out of the 4 cases who did achieve HR, 1 was in chronic phase, 1 in accelerated phase and 2 in blast crisis.
Conclusions: In our study, a prospective analysis was made for newly diagnosed, treatment naïve CML patients at the time of diagnosis and after 6 weeks of Imatinib mesylate. The mean age of presentation is a decade younger than the west. The patients hardly get detected in the asymptomatic stage in our country. There is a higher proportion of patients in the accelerated and blast crisis. Furthermore, TKIs (mostly Imatinib) is the chemotherapy available in majority. All these factors combined herald dismal prognosis for patients in a developing country as compared to the West.
In our study, majority of the hematological parameters showed remarkable improvement on Imatinib, which highlights the importance of an early diagnosis and timely institution of chemotherapy in all the patients of CML.