A Ten-Year Experience of Treating Chronic Myeloid Leukemia in Rural Rwanda: Outcomes and Insights for a Changing Landscape.
A Ten-Year Experience of Treating Chronic Myeloid Leukemia in Rural Rwanda: Outcomes and Insights for a Changing Landscape.
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卢旺达农村地区治疗慢性粒细胞白血病的十年经验：对不断变化的景观的结果和见解。
DOI：
10.1200/go.22.00131
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发表时间：
2022-07
影响因子：
4.5
通讯作者：
中科院分区：
文献类型：
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作者：
在描述我们作为Glivec患者援助计划（GIPAP）在卢旺达农村地区治疗慢性粒细胞白血病（CML）的十年经验时，我们评估了（1）患者特征和治疗结果，（2）资源适应性管理策略，以及（3）诊断能力发展的影响。我们回顾性分析了2009年至2018年期间入组该GIPAP项目的所有BCR-ABL阳性CML患者。使用描述性统计、Kaplan-Meier方法、比例风险回归和Kruskal-Wallis检验分析临床数据。共纳入124例患者。诊断时的中位年龄为34岁（范围8-81岁）。伊马替尼治疗组中，91%的患者在中位49天后达到完全血液学缓解（CR）。分别有7例（6%）和12例（11%）患者出现原发性和继发性伊马替尼耐药。队列的3年总生存率为80%（95%CI，72 - 87），伊马替尼应答者的上级生存率优于原发性和继发性耐药者。从伊马替尼治疗开始到停用的中位时间为59天，而在国内诊断测试之前和之后为38天（P = 0.040），而中位诊断时间（P = 0.056）和伊马替尼治疗开始时间（P = 0.170）没有显著差异。在一个全面的癌症护理提供计划中，将分子诊断与负担得起的伊马替尼的使用相结合，是在资源有限的环境中治疗CML的一种成功的长期策略。与高收入国家的历史队列相比，我们的患者更年轻，伊马替尼耐药率更高。高伊马替尼耐药率突出了获得分子监测、耐药检测和第二代酪氨酸激酶抑制剂以及支持药物依从性的系统的需求。在这种情况下，血液学反应是一个准确的资源适应性生存预测因子。当地诊断能力的发展使卢旺达能够持续、及时地提供CML护理。
In describing our ten-year experience with treating chronic myeloid leukemia (CML) as part of the Glivec Patient Assistance Program (GIPAP) in rural Rwanda, we evaluate (1) patient characteristics and treatment outcomes, (2) resource-adapted management strategies, and (3) the impact of diagnostic capacity development. We retrospectively reviewed all patients with BCR-ABL–positive CML enrolled in this GIPAP program between 2009 and 2018. Clinical data were analyzed using descriptive statistics, Kaplan-Meier methods, proportional hazards regression, and the Kruskal-Wallis test. One hundred twenty-four patients were included. The median age at diagnosis was 34 (range 8-81) years. On imatinib, 91% achieved complete hematologic response (CHR) after a median of 49 days. Seven (6%) and 12 (11%) patients had primary and secondary imatinib resistance, respectively. The 3-year overall survival was 80% (95% CI, 72 to 87) for the cohort, with superior survival in imatinib responders compared with those with primary and secondary resistance. The median time from imatinib initiation to CHR was 59 versus 38 days (P = .040) before and after in-country diagnostic testing, whereas the median time to diagnosis (P = .056) and imatinib initiation (P = .170) was not significantly different. Coupling molecular diagnostics with affordable access to imatinib within a comprehensive cancer care delivery program is a successful long-term strategy to treat CML in resource-constrained settings. Our patients are younger and have higher rates of imatinib resistance compared with historic cohorts in high-income countries. High imatinib resistance rates highlight the need for access to molecular monitoring, resistance testing, and second-generation tyrosine kinase inhibitors, as well as systems to support drug adherence. Hematologic response is an accurate resource-adapted predictor of survival in this setting. Local diagnostic capacity development has allowed for continuous, timely CML care delivery in Rwanda.
影响因子：
--
作者：
Dos Reis SR;Quixadá AT;Nunes ST;Cid DM;de Souza JH;da Costa CM;Silveira CB;Cid DA;de Oliveira MF
通讯作者：
de Oliveira MF
影响因子：
10.8
作者：
Kanavos P;Vandoros S;Garcia-Gonzalez P
通讯作者：
Garcia-Gonzalez P