Evaluation of molecular monitoring and response milestone of patients with chronic myeloid leukemia to tyrosine kinase inhibitors in Middle Euphrates of Iraq

Abstract

Background: In the last decade, tremendous changes occurred in the treatment and follow-up of the patients with chronic myeloid leukemia (CML), with continuous update in the close molecular monitoring of treatment for the presence of minimal residual disease. Objectives: The objective of this study was to evaluate the molecular monitoring of patients with CML on tyrosine kinase inhibitor (TKI) treatment and categorization of those patients according to the European Leukemia Net (ELN) guidelines. Materials and Methods: This observational cross-sectional study was conducted among all patients with CML registered in Oncology and Hematology Centers in Middle Euphrates of Iraq including 244 patients from April 2013 to April 2016. Eligible patients were 199 cases while 45 cases were excluded from the study. Venous blood in ethylenediaminetetraacetic acid was collected with each time of molecular monitoring to assess the level of messenger RNA of breakpoint cluster region-Abelson (BCR-ABL) by quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) (Cepheid, Gene Xpert Diagnostic System). Results: Most of the patients were in young adult age group with disease predominance more in females than males. Majority of the patients (72%) achieved optimal response after 12 months of treatment according to the ELN guidelines and 28% showed primary resistance to TKI. Some patients with optimal response (9%) will develop secondary resistance to treatment. Conclusion: Most of our patients achieved major molecular response after 12 months of treatment with TKI according to the ELN guidelines that reflect proper management and regular follow-up of the patients by quantitative RT-PCR for the detection of BCR-ABL level.

Keywords

• BCR-ABL
• chronic myeloid leukemia
• Iraq
• molecular monitoring
• tyrosine kinase inhibitors