The Effect of Imatinib Mesylate for Newly Diagnosed Philadelphia Chromosome-Positive, Chronic-Phase Myeloid Leukemia in Sub-Saharan African Patients: The Experience of Côte d'Ivoire.

Imatinib mesylate, showed encouraging activity in chronic myelogenous leukemia. However, there are few data regarding his efficacy and response monitoring in Sub-Saharan African patients. Our objective was to assess response to imatinib mesylate (Glivec) in Côte d'Ivoire patients with newly diagnosed Chronic Myeloid Leukemia (CML). From May 2005 to September 2009, we treated 42 patients (40 years; range 16-69) with Philadelphia chromosome (Ph+) positive in chronic phase CML with oral imatinib mesylate at daily doses of 400 mg. Overall survival (OS) and frequency of complete or major cytogenetic remission (CCR/MCR) were evaluated. At a median follow up of 32 (range 7.6-113) months, the CHR rate in our study group was 76%. A major CR was found in 19 patients (45%) with 17% and 29% complete and partial CR respectively. There were no significant differences in the incidence of major cytogenetic response by known prognostics factors. Median time to CHR was 8 months (range 0.4-25), and 16 months (range: 0.1-36) for CR. Projected 5-year OS rate was 72% (95%CI 42-88). We conclude that imatinib therapy sub-Saharan African CML patients is very promising and has favorably changed the prognosis for black African patients with CML.

[Therapeutic impact of alpha interferon in chronic myelogenous leukaemia]. / Impact therapeutique de l'interferon alpha dans la prise en charge des patients atteints de leucemie myeloide chronique.

CONTEXT: Ten years after the use of alpha interferon in chronic myelogenous (CML) leukaemia treatment, we review this treatment. OBJECTIVE: We propose through this study to evaluate the therapeutic answer of the patients reached of CML in chronic phase and to study its impact on survival. MATERIAL AND METHODS: To be done we carried out a descriptive and analytical retrospective study concerning 40 patients carrying Chronic Myelogenous Leukaemia. RESULTS: The average age was 39.05 years and ratio sex was 0.9. 60% of the patients profited from the arm Hydroxyurea + Interferon alpha + Cytosine Arabinoside and 40% from Hydroxyurea + Interferon. The complete haematological answer was observed in 85.5%. The cytogenetic answer was documented only for two cases, and it acted of complete answer. On the evolutionary level, it was noted 27.5% of deaths related to a blastic transformation. The side effects were marked by occurred of alopecia, herpes and the gripal syndrome. The median of survival observed was 68.233 months or 5.68 years. The age, socioeconomic level, delay of treatment started, therapeutic protocol, length and regularity of treatment influenced the therapeutic response. CONCLUSION: Many factors influence the treatment response.

[Chronic lymphocytic leukemia in Subsaharian Africa: clinical outcome experience of Côte d'Ivoire]. / La leucémie lymphoïde chronique du Noir en Afrique subsaharienne : caractéristiques cliniques thérapeutiques et pronostiques (cas de la Côte d'Ivoire).

We reported in this retrospective study the clinical outcome of 56 chronic lymphoïd leukemia of black African in Ivory Coast and the predicting prognosis factors. The mean age was 62 years old with average of 38 to 84 years. According to Binet staging, 29 patients with stage A, and respectively 11 and 16 patient for stage B and C. All patient received chemotherapy protocol regimens (CVP, chlorambucil, CHOP). The global response was 51.78%. The death occurred in 29 patients. The mean survival was 8.22 years. The disease free survival was 58.8% at 5 years. In univariate analysis, factors with high-risk of death are patients age above 60 years, the presence of node, liver involvement, Spleen large IV and V of Hackett classification, WBC superior to 100,000/microL, lymphocytosis superior to 63,000/microL, Anaemia inferior to 10 g/dL, thrombopenia inferior to 100,000/microL, medullar lymphocytosis superior to 73% and Binet Stage B and C. In multivariate analysis, only age, adenopathy, hepatomegaly and lymhocytosis were an independent prognostic factor for predicting survival.

[Is hepatomegaly a prognosis factor of chronic myeloid leukaemia among African blacks?]. / L'hepatomegalie est-elle un facteur pronostic de la LMC du Noir Africain?

It acts of a retrospective study relating to 74 patients reached of chronic Leukaemia myeloid (LMC) over one 5 year period followed in the clinical service of hematology of the University Hospital of Yopougon (Abidjan, Ivory Coast). The splenomegaly is quasi-constant in chronic phase of the disease often associated hepatomegaly in 20.27% of the cases which constitutes a pejorative factor of the LMC. Indeed, the hyperleukocytosis of more than 300,000 white globules is correlated with the presence of hepatomegaly (p=0.0005) with risks of portal hypertension. 80% of the patients carrying the LMC with a clinical hepatomegaly in chronic phase of the disease have against an incomplete hematologic remission 20% of complete remission (P = 0.002) among patients without hepatomegaly. The strong rate of death (73.33%) recorded occurred among patients carrying a hepatomegaly against 15.25% of death without hepatomegaly (P = 0.0001). The overall rates Total survival is on average 17 months against 20 months 28 days in the event of absence of the hepatomegaly (P = 0.0001).