Dasatinib As a Late Second Line Therapy in Chronic Myeloid Leukemia Patients: A Retrospective Study From a Tertiary Care Centre in India

Chronic myeloid leukemia in Indian patients manifests a decade earlier than reported in the West. However, patients present later to the hospital, with advanced disease as evinced by large spleen size, fever and other symptoms and a high Sokal score. The cost of medicines and lack of health insurance means that most will receive Imatinib mesylate (Glivec) from the GIPAP program only, or locally produced Imatinib. The usual option for imatinib failure is to increase the dose to 600 or 800mg. Switching patients to second line therapy is difficult due to financial constraints; patients who fail Imatinib are offered allogeneic stem cell transplantation.

We present a single-institution retrospective data of Dasatinib as second line therapy in CML patients resistant to imatinib. In a total of 1200 CML patients followed in our clinic, 24 patients were treated with dasatinib over a period of 4 years. 17 of whom were in chronic phase (switched after failure of Interferon and Imatinib -2, not in CHR at time of switch- 4), accelerated phase-5 and blast crisis-2 patients, at the time of starting dasatinib. They either refused transplant, did not have donor or had co-morbid factors (3-diabetes mellitus and CVD, 1- chronic renal disease along with diabetes) which made transplant difficult.

The median age of patients was 45 years (26–65 years) with 12 males and 12 females. They had received imatinib for a median of 50 months (20–98 months) before starting dasatinib. After a median follow up of 12 months (6.6 – 39.6 months), there was 2 deaths (CML-BC-1, CML-AP-1). Non-hematologic toxicity was generally mild to moderate (grades 1 or 2); dyspnea, gastrointestinal disorders (diarrhea, nausea) and fluid retention were seen. Pleural effusion occurred in two patients.

Toxicities with Dasatinib were generally reversible and could be managed effectively with dose adjustments. Our limited experience showed this to be effective and well tolerated even in late failure patients with high disease burden.

No relevant conflicts of interest to declare.