Clinical features of Chronic myeloid leukaemia patients on Imatinib: A telephonic retrospective study.

Background:

Chronic Myeloid Leukaemia (CML) is a myeloproliferative disorder of the haemopoietic clonal cells carrying the Philadelphia chromosome in 95% cases which results from the reciprocal translocation between long arms of chromosomes 9 and 21 t(9;22)(q34;11), leading to the formation of BCR-ABL fusion gene, that constitutively produces Tyrosine Kinase. Beyond normal activity of this enzyme is responsible for the carcinogenesis in CML. Imatinib, a tyrosine kinase inhibitor, inhibits the oncogenic pathway in CML. Imatinib has been a great success in terms of cytogenic and haematological response since its approval by FDA. Imatinib is well tolerated, but is associated with mild to moderate toxicity that can be managed by dose reductions or discontinuation. Common side effects include GI intolerance, rash and myalgia. Adherence to Imatinib is the key to complete therapeutic response but there are multiple compliance limiting factors, like unavailability, side effects and one of the recent factors being the COVID19 pandemic. This study highlights the challenges faced by the CML patients on Imatinib in terms of side effects and factors that limit the adherence to therapy.

Materials and Methods:

Study Design: Retrospective telephonic hospital based observational study

Method: We reviewed the Chemotherapy register of Assam Medical College and Hospital and attempted to contact CML patients who have indented Imatinib in the last 5 months.

Total 59 patients indented the drug in this time span, out which 27 patients could not be contacted. Remaining patients were asked regarding any complaints and compliance to the therapy after taking due consent.

Result: The study involved 32 patients, 34.3% Female and 65% Male, with a median age of 48. While 37.5% patients didn’t have any side effect, most common side effect was Gastrointestinal intolerance, 31.25%(nausea, vomiting, loose stool and abdominal discomfort), followed by equal occurrence of other side effects (6.25%);myalgia, facial puffiness, weight gain, tingling sensation, skin rash, itching and one case of haematuria.

Out of the 32 patients, 43.75% patients have been strictly adherent to the therapy. Among others 25%(8) patients could not take the medicine due to lockdown imposed in 2020 due to COVID19 pandemic;18.75%(6) concurrent illness; 12.5%(4) drug unavailability; 6.25%(2) poor quality of the drug and 1 patient switched to herbal medication temporarily.

CONCLUSION:

While one third patients didn’t have any complaint, GI intolerance is the most common among the rest. Among the other factors, the ongoing COVID19 pandemic has emerged out as an important adherence limiting factor in CML followed by concurrent illness and drug unavailability. This study emphasizes the need for ensuring the quantity, quality and delivery of the drug to an extent that is minimally affected by the pandemic and also highlights the importance of disease awareness to prevent less educated people switching to alternative treatment like herbal medications.