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Abstract
The study was conducted on 98 children and adolescent diagnosed as CML during the period between January 1995 to December 2005,in the Pediatric Hematology /Oncology Unit Children Hospital Ain Shams University , National Cancer Institute and Nasser Institute . Patients were eligible for the study if they had received adiagnosis of chronic myeloid leukemia confirmed by karyotyping with positive philadilphia chromosome and by presence of BCR – ABL translocation by Florescent In Situ Hypredization (FISH) technique and cytogenetic study.
Follow up of patients was done till December 2008. We reviewed the records of 98 children and adolescents who were treated for CML in the three Egyptian centers.
The symptoms, physical signs, and peripheral blood and bone marrow analysis at initial diagnosis of CML were recorded. Stage of the disease (chronic phase, accelerated phase, or blast crisis) was classified according to the criteria of the International Bone Marrow Transplant Registry.
The patients were divided into four groups according to therapy instituted:
Group 1: 36 patients that were diagnosed in the period between January 1995 till the end of December 2005 and undergone Bone marrow transplantation.
Group 2:15 patients that were diagnosed in the period between January 2003 till the end of December 2005 received Imatinib mesylate in a dose 260-570 mg/m2/d.
Group 3 :30 patients that were diagnosed in the period between January 1995 till the end of December 2002 and received Hydroxyurea in a dose of 10-20mg /kg/d .
group 4 :17 patients that were diagnosed in the period between January 1995 till the end of December 2002 and received other therapies like cytarabine and interferon alfa, due to unavailability of hydroxyurea and Imatinib mesylate .
a slight male preponderance has been reported, 58% of children in our study were older than 10 years at diagnosis.
In this retrospective study, we compare the results of management of CML in 98 children and adolescents with different standard therapies; BMT, Imatinib mesylate, Hydroxyurea , other therapies like Arabinosoid cytarabine and Interferon alpha after median follow up period of 52 months. According to all variables measured, including the rates of complete hematologic response, cytogenetic response, freedom from progression to accelerated phase or blast crisis CML, tolerance to therapy and outcome, Imatinib was significantly superior to other treatment options.
Imatinib seems to be the initial treatment of choice for patients with CML who do not have a suitable bone marrow donor or who are not candidates for transplantation.