Chronic Myeloid Leukemia (CML) in Adolescents & Young Adults (AYA): Single Institution 10 Years Experience with 1^st Line Imatinib Mesylate (IM)

Introduction and Aims:

CML is the commonest adult leukemia in India and the disease is diagnosed commonly in the 3^rd or 4^th decade of life - at least 10 years earlier than in the west, making the disease an important issue in AYA cancers.

The present study reports our 10 year experience (all patients registered after 2005 with minimum of 3 years follow up) with the use of 1^st line IM in patients of CML Chronic Phase (CML-CP) in patients aged 15 to 29 years.

Methods:

Patients of CML-CP receiving 1^st line IM, aged 15 to 29 were included in the study. Standard demographics; hematological response, molecular responses (RQ-PCR on International Scale) q 6 monthly and toxicity of IM were assessed.

Results

A total of 337 patients of CML-CP were registered, 89 (28.7%) of which were aged between 15 to 29 and were on 1^st line IM. These are reported in this study.

Age distribution: 15 to 19 years: 17 (19.1%); 20 to 24: 26 (29.2%); 24 to 29: 46 (51.7%). Male female ratio: 53 (59.5%) to 36 (40.5%).

Sixty one (68.5%) received innovator IM (Glivec) through the GIPAP (Glivec International Patient Assistance Program), 28 (40.5%) generic IM.

At 10 years f/u, 6 (6.7%) patients were lost to f/u, 15 (16.8%) off imatinib (12 sub-optimal molecular response/relapse, and 3 b/o toxicity - 2 hepatitis, 1 renal). Seventy four (74) patients continue on IM, 56 on 400 mg/day and 18 on > 400mg/day. Fifty nine are in deep molecular response, 15 have a bcr/abl between 0.1 to 1.0 but are in complete hematological remission.

Musculo-skeletal toxicity, grade I to II: 11/74 (14.8%), skin toxicity grade I: 27/74 (36.5%) and GI grade I to II: 16/74 (21.6%) were seen.

Discussion and Conclusion

CML is a common cancer in AYA in developing countries. IM, including generic IM, remains the standard 1^st line drug for the majority and is effective, well tolerated in most patients. Issues related to treatment-free-remission (TFR), compliance, long-term drug toxicity and fertility need to be studied in this young population.