Evaluation of clinical features and treatment responses in patients with chronic myeloid leukemia: A single center experience

Öz

Background: Chronic myeloid leukemia is a clonal hematopoietic stem cell disorder that leads to an increase in myeloid cells, erythroid series, and platelets in peripheral blood and causes pronounced myeloid hyperplasia in the bone marrow. The treatment and follow-up criteria in patients with CML have changed significantly in the recent years. In the pre-imatinib period, CML has been treated with hydroxyurea, interferon therapy, chemotherapy, and most effectively, allogenic stem cell transplantation. The addition of imatinib mesylate, a tyrosine kinase inhibitor, to the treatment regime provided a superior overall survival rate compared to previous standard treatments. In this study, our aim is to demonstrate the demographic characteristics, clinical features, treatment and follow-up strategies, response status, and general survival rates of CML patients treated in our clinic. Materials and Methods: 110 patients who were diagnosed with chronic phase CML during 2003–2019 were included in this study. The demographic characteristics and clinical findings including laboratory values, ultrasound findings, and bone marrow pathology results were evaluated retrospectively from their medical records Results: Among the 110 patients included, 59 (53.6%) were male, and 51 (46.4%) were female, and the median age was 49.5 (18–82). At the time of diagnosis, only 32 (29.0%) patients were symptomatic, 71 (64.5%) had splenomegaly, and 51 (46.4%) had hepatomegaly. All patients were given 400 mg of imatinib as first-line therapy. With imatinib treatment, the rates of complete hematologic response (CHR), complete cytogenetic response (CyCR), and major molecular response (MMR) were 100.0%, 72.5% and 69.6%, respectively. In the follow-up, 3 (2.7%) patients were observed to progress to the blastic phase. The overall survival rate was 86.4%. Conclusions: Imatinib has proven to be a tolerable, effective and safe agent in the first-line treatment of CML patients. Treatment choice after imatinib should take into consideration the patients' comorbidities.

Anahtar Kelimeler

• chronic myeloid leukemia
• tyrosine kinase
• treatment response

Kronik Myeloid Lösemi Tanılı Hastaların Klinik Özellikleri ve Tedaviye Yanıtlarının Değerlendirilmesi: Tek Merkez Deneyimi

Öz

Amaç: KML periferik kanda miyeloid hücreler, eritroid seri ve trombositlerin artmasına yol açan, kemik iliğinde de belirgin miyeloid hiperplazisine neden olan klonal hematopoetik bir kök hücre hastalığıdır. KML tanılı hastaların tedavi ve takip kriterleri son yıllarda önemli oranda değişmiştir. İmatinib öncesi dönemde KML hidroksiüre, interferon, kemoterapi ve en etkili şekilde de allojenik kök hücre nakli ile tedavi edilmiştir. Tirozin kinaz inhibitörü imatinib mesilatın tedaviye eklenmesi önceki standart tedavilere kıyasla daha üstün bir genel sağ kalım sağlamıştır. Bu çalışmadaki amacımız, kliniğimizde tedavi edilen KML hastalarının demografik özelliklerini, klinik özelliklerini, tedavi ve izleme stratejilerini, yanıt durumlarını ve genel sağ kalım oranlarını belirlemektir.
Materyal ve Metod: 2003 ve 2019 tarihleri arasında kronik faz KML tanısı koyulan ve dosya kayıtlarına ulaşılabilen 110 hasta çalışmaya dahil edildi. Hastaların demografik özellikleri, klinik bulguları, laboratuvar değerleri, ultrasonografi bulguları ve kemik iliği patoloji sonuçları değerlendirildi.
Bulgular: 110 tane hastanın 59 (%53.6) tanesi erkek, 51 (%46.4) tanesi kadındı. Tanı anındaki medyan yaş 49.5 (18-82) saptandı. Tanı anında sadece 32 (%29.0) hasta semptomatikti. Hastaların tanı anında 71 (%64.5) tanesinde splenomegali ve 51 (%46.4) tanesinde hepatomegali vardı. Tüm hastalara ilk basamakta imatinib 400 mg verilmişti. İmatinib tedavisi ile 12. ayda THY oranı %100, TSY oranı %72.5 ve MMR oranı ise %69.6 saptandı. Takiplerde 3 (%2.7) hastanın blastik faza progrese olduğu görüldü. Tüm hastaların OS oranı %86.4 saptandı.
Sonuç: KML hastalarının ilk basamak tedavisinde imatinib tolere edilebilir, etkili ve güvenli bir ajan olduğunu kanıtlamıştır. İmatinib sonrası tedavi değişikliği yapılırken hastaların komorbiditeleri göz önünde bulundurulmalıdır.

Anahtar Kelimeler

• Kronik myeloid lösemi
• tirozin kinaz
• tedavi yanıtı

Kaynakça

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