Background: Chronic Myeloid Leukemia (CML) is caused by the abnormal fusion protein BCR-ABL1, a constitutively\r\nactive tyrosine kinase and product of the Philadelphia chromosome. Gleevec (Imatinib mesylate) is a selective\r\ninhibitor of this kinase. Treatment with this agent is known to result in hematologic, cytogenetic, and molecular\r\nresponses. Patan hospital (Patan, Nepal) is one of the Gleevec International Patient Assistance Program (GIPAP)\r\ncenters for patients with CML.\r\nMethods: A total of 106 Philadelphia positive CML patients were enrolled in our center between Feb 2003 and\r\nJun 2008, and 103 of them were eligible for cytogenetic and/or hematologic response analyses.\r\nResults: Out of 103 patients, 27% patients underwent cytogenetic analysis. Imatinib induced major cytogenetic\r\nresponses in 89% and complete hematologic responses in almost 100% of the patients with confirmed CML. After\r\na mean follow up of 27 months, an estimated 90% of the patients on imatinib remained in hematologic remission\r\nand more than 90% of the patients are still alive. About 30% of patients developed some form of manageable\r\nmyelosuppression. A few patients developed non-hematologic toxic side effects such as edema and hepatotoxicity.\r\nConclusions: Our study demonstrates that imatinib is safe to use in a developing country. Furthermore, we\r\ndemonstrate that imatinib is very effective and induced long lasting responses in a high proportion of patients\r\nwith Ph chromosome/BCR-ABL1 positive CML. Imatinib is well tolerated by our patients. The lack of cytogenetic\r\nanalysis in the majority of our patients hindered our ability to detect inadequate responses to imatinib and adjust\r\ntherapy appropriately.
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