Response to Imatinib Mesylate in patients with Chronic Myeloid Leukemia.

Joseph John, M (2006) Response to Imatinib Mesylate in patients with Chronic Myeloid Leukemia. Masters thesis, Christian Medical College, Vellore.


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INTRODUCTION : It was in the year 1960, Nowell and Hungerford discovered the “minute chromosome”. More than a decade later, Janet rowely’ described the presence of t(9;22). This has lead to the evolution in treatment of CML from “carpet bombing” to the modern day targeted therapy, the “magic bullet” – Imatinib Mesylate. In June 1998, the drug was given to the first human volunteer with CML in the phase I trial. Patients were either unresponsive to interferon (IFN), or in advanced phase. In the next three phase II trials, the efficacy of this drug in all the phases of CML were confirmed. However, it was the landmark phase III trials that established its present status as the first line drug of choice in the management of newly diagnosed cases of CML. This multicentre prospective trial proved its true virtue with clear superiority in cytogenetic response rates as compared with the “gold standard” of that time; INF administered along with low dose cytosine. OBJECTIVE: To assess the response to imatinib mesylate in patients with chronic myeloid leukemia in chronic and advanced phase who came to our institution from January 2002 to December 2005. METHODS: All Chronic Myeloid Leukemia patients who were eligible to enroll into GIPAP (Glivec International Patient Assistance Program) for imatinib were included for analysis. Response to treatment was analyzed by peripheral blood counts and peripheral blood FISH analysis for t(9;22) at various intervals. This was subsequently correlated with overall survival and progression free survival using log-rank test. RESULTS: A total of 243 patients were enrolled into the study (CP-202, AP – 13, BT – 28). Complete haematological remission was achieved in 91% of patients in CP, 69% in AP and 57% in BT. Major cytogenetic remission was observed in 70% of patients in CP, 33.3% in AP and 28.5% in BT. Complete cytogenetic remission was observed in 51.2% of patients in CP, 33.3% in AP and 14.2% in BT. The overall survival in CP was 98%, and for AP and BT, it was 54% and 51%. The Progression Free Survival in CP was 81% and for accelerated and blast crisis, it was 48% and 64%. CONCLUSION: There is significant hematological and cytogenetic response to Imatinib Mesylate in patients with chronic myeloid leukemia.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Imatinib Mesylate ; Patients ; Chronic Myeloid Leukemia.
Subjects: MEDICAL > Clinical Haematology
Depositing User: Subramani R
Date Deposited: 16 Aug 2017 00:42
Last Modified: 16 Aug 2017 04:34

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