Abstract
Background
In Nigeria, since 2002, Imatinib mesylate (glivec®) has been available freely to chronic myeloid leukaemia (CML) patients but only at a tertiary health care centre in the south western part of the country. Despite this, it is not readily accessible to many patients due to the distance and other challenges including low socioeconomic status and political problems, thereby preventing timely access specialist care. This study evaluated the effect of the baseline characteristics on the prognostic implication and treatment outcome of CML patients in Nigeria.
Method
This study retrospectively evaluated the medical records of 889 CML patients over an 18 years period (2002–2020). Of these, 576 (65%) patients had complete information with up-to-date BCR::ABL1 record. These 576 patients were categorized based on their responses to Imatinib therapy into three groups viz; Optimal response (OR) defined as BCR::ABL1 ratio of < 0.1% or major molecular remission, Suboptimal response (SR) with BCR::ABL ratio of 0.1–1%, and Treatment failure (TF) when MMR has not been achieved at 12 months. The variables were analyzed using descriptive and inferential statistics and a p-value < 0.05 was considered statistically significant.
Results
The result revealed a median age of 37 years at diagnosis with a male to female ratio of 1.5:1. The majority (96.8%) of the patients presented with one or more symptoms at diagnosis with a mean duration of symptom of 12 ± 10.6 months. The mean Sokal score was 1.3 ± 0.8, with almost half (49%) presenting with a high score. There was a statistically significant positive correlation between Sokal score and duration of symptoms at presentation (r = 0.733, p = 0.011). Based on response categorization, 40.3% had OR while 27.1% and 32.6% had SR and TF respectively.
Conclusion
Low optimal response of 40.3% and treatment failure of 32.6% in CML patients while on first line Imatinib (Glivec®) therapy in our cohort is strongly attributable to long duration of symptoms (> 12months) and high-risk disease (high Sokal score) at presentation. We advocate prompt access to specialist care and de-centralization of the free Imatinib program in Nigeria.