En Asie
Chronic myeloid leukemia in Asia
Wing Y. Au, Priscilla B. Caguioa, Charles Chuah, Szu Chun Hsu,
Saengsuree Jootar, Dong-Wook Kim,Il-Young Kweon, William M. O’Neil ,
Tapan K. Saikia, Jianxiang Wang
The Japanese Society of Hematology 2008
''Chronic myeloid leukemia (CML) in Asia has an incidence rather lower than in Western countries yet
tends to afflict a younger population. As in the West, imatinib mesylate (IM, Glivec) has supplanted busulphan,
hydroxyurea and interferon-a as first-line treatment. Its use has resulted in a dramatic decline in the number of
hematopoietic stem cell transplantations (HSCT) performed. Although it is expensive, IM induces a complete
cytogenetic response in 60–90% of newly diagnosed patients, and up to 10% for those in blastic phase. The
standard dose of 400 mg is well tolerated by most patients,although adverse events have been observed, including
drug-induced cytopenia. Through the Glivec International Patient Assistance Program, the majority of CML patients
has access to IM and can expect prolonged survival, even in the absence of HSCT. However, just as in Western
countries, resistance to imatinib has emerged in Asian countries. They will require the novel tyrosine kinase
inhibitors (dasatinib, nilotinib) becoming available through either clinical trials or market approval. This review
examines the available data on CML in China, Hong Kong,India, the Philippines, Singapore, South Korea, Taiwan and
Thailand.
Conclusion - In terms of prevalence, CML is the most common hematological malignancy in Asia, but its incidence and median
age of onset may be lower than that observed in the US. Treatment options for CML in Asia have changed
dramatically over the past decade, and patients can expect prolonged median survival, even without HSCT. This
change has been spurred by the introduction of IM,beginning in 2001. Although it is extremely efficacious and
well-tolerated in most patients, IM-resistance has become a significant hurdle for some patients. The development of
second-generation TKIs such as dasatinib, nilotinib and bosutinib may prove to be an important alternative for such
patients in Asian countries.Throughout the region however, the economic burden of the disease is growing as new treatment options introduce not only new drug costs but may require ever more sophisticated monitoring.''
Extrait de http://www.springerlink.com/content/5j8u6172vx306009/