Traitement de la LMC dans le monde non occidental

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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/

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Au Pakistan
Sustained Superior Long-Term Outcomes and Cytogenetic Responses with Imatinib Mesylate in Chronic Phase Chronic Myeloid Leukaemia: Report from a Developing Country.
Aziz Z, Iqbal J, Bano K, Faisal M, Akram M.
Department of Oncology, Allama Iqbal Medical College, Lahore, Pakistan.
'Imatinib mesylate is now a standard treatment for chronic myeloid leukaemia. Primary objective of our study was to report long-term survival outcomes in patients receiving Imatinib in chronic phase. Secondary objectives included determination of cytogenetic responses and toxicity profile of Imatinib mesylate. METHODS: Three-hundred and four consecutive patients with chronic phase chronic myeloid leukaemia were evaluated between January 2001 to December 2007, for event-free survival, overall survival, complete cytogenetic response and toxicity profiles. Event-free and overall survivals were calculated by Kaplan-Meier estimates. Cox regression analysis was performed to evaluate the prognostic factors for survival. Univariate and multivariate analyses were performed for factors predictive of a complete cytogenetic response. RESULTS: Median follow-up was 48 months. Estimated 5-year event-free and overall survivals of all patients were 79% and 86%, respectively. On Cox regression analysis significant predictive factors for event-free survival were age < 50 years (P 0.002), complete cytogenetic response (P < 0.0001), low Sokal score (P 0.007), complete clinical (P < 0.0001) and haematological response (P < 0.0001). Complete cytogenetic response was achieved in 206 (67.8%) patients. On multivariate analysis, low Sokal score (P < 0.0001) and early chronic phase disease (P < 0.0001) emerged as the most significant predictors for achieving a complete cytogenetic response. An estimated 5.8% patients lost their complete cytogenetic response. Grade III/IV toxicity was observed in only 21 patients. CONCLUSIONS: Long-term treatment with Imatinib mesylate results in superior and durable responses in chronic phase chronic myeloid leukaemia. Our survival outcomes are similar to reported rates in the Western population.'
http://www.ncbi.nlm.nih.gov/pubmed/2018 ... dinalpos=1

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Aux Indes
Imatinib mesylate in early chronic phase chronic myeloid leukemia: Experience from a developing country
Senthil Rajappa, Lalit Varadpande, Tara Paul, Rachel Jacob and Raghunadharao Digumarti
Department of Medical Oncology
Department of Pathology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, 500082, India
'There are few publications on responses of patients with chronic phase chronic myeloid leukemia (CP-CML) from the Indian sub continent to imatinib mesylate (IM). This study analyses the response rates, progression free survival (PFS), overall survival and adverse events of early CP-CML patients on IM. Analysis of patients with untreated early CP-CML on IM from 2003 to 2006 was done. Standard criteria for hematological and cytogenetic responses were used. There were 201 patients with a median follow-up of 29.5 months. Thirty three percentage, 40% and 27% belonged to the low, intermediate and high-risk Hasford groups, respectively. Ninety seven percentage achieved complete hematological response. Fifty six percentage achieved complete cytogenetic response (CCR), 23% partial cytogenetic response, 17% minor response and 4% no response. The estimated PFS and OS at 29 months for the whole group was 77 and 94%, respectively. Hasford risk groups were predictive of CCR (p = 0.0018). None required permanent drug discontinuations due to adverse events. This study shows sub optimal outcomes to IM in early CP-CML. Late presentation may be one of the reasons for these outcomes. IM was well tolerated.'
Extrait de http://informahealthcare.com/doi/abs/10 ... alCode=lal