Treatment and Survival in Patients with Chronic Myeloid Leukemia in a Chronic Phase in West Iran

  • Payandeh, Mehrdad (Department of Hematology and Medical Oncology, Kermanshah University of Medical Sciences) ;
  • Sadeghi, Masoud ;
  • Sadeghi, Edris
  • Published : 2015.12.03


Background: CML includes 30% of all leukemias, and occurs from childhood to old age. The present study was a retrospective analysis of chronic phase CML patients registered to a Hematology Clinic in Kermanshah, Iran, with checking of treatment options. Materials and Methods: Between 2002 and 2014, 85 CML patients referred to our hematology clinic were enrolled in our study. We surveyed age, sex, B-symptoms, splenomegaly, Sokal score, Hasford score, treatment and survival in all patients. Philadelphia chromosome analysis was conducted for each patient by conventional cytogenetics. We compared treatment in the patients with three drugs, imatinib, hydroxyurea (HU) and interferon alpha (IFN-${\alpha}$). Results: The mean age of the patients at diagnosis was $47.5{\pm}14.5years$ (range, 23-82 years), with 43 (50.6%) being male. Some 13 (15.3%) were referred to our clinic for the first time with B-symptoms and 44 patients (51.8%) had splenomegaly. The Sokal score for 77 (90.6%) was low, 4 (4.7%) was intermediate and 4(4.7%) was high, but Hasford (Euro) scores for all patients were low. The 5-year survival rate for treated patients with imatinib, imatinib plus HU and imatinib plus HU plus IFN-${\alpha}$ was 90.5%, 81.1% and 55.6%, respectively Conclusions: The results show that imatinib therapy alone provides better survival in CML patients compared to HU or IFN-${\alpha}$. Combinations of IFN-${\alpha}$ and/or HU with imatinib probably reduce survival.


Chronic myeloid leukemia;imatinib;interferon alpha;survival


  1. Allan NC, Richards SM, Shepherd PC, et al (1995). UK Medical Research Council randomised, multicentre trial of interferonalpha n1 for chronic myeloid leukaemia: improved survival irrespective of cytogenetic response, Lancet, 345, 1392-7.
  2. Baccarani M, Rosti G, de Vivo A, et al (2002). A randomized study of interferon-alpha versus interferon-alpha and lowdose arabinosyl cytosine in chronic myeloid leukemia. Blood, 99, 527-1535.
  3. Berger U, Maywald O, Pfirrmann M, et al (2005). Gender aspects in chronic myeloid leukemia: long-term results from randomized studies. Leukemia, 19, 984-9.
  4. Bhat G, Bhat A, Wani A, et al (2012). Polymorphic variation in glutathione-S-transferase genes and risk of chronic myeloid leukaemia in the Kashmiri population. Asian Pac J Cancer Prev, 13, 69-73.
  5. Chavan D, Ahmad F, Iyer P, et al (2006). Cytogenetic investigation in chronic myeloid leukemia: study from an Indian population. Asian Pac J Cancer Prev, 7, 423-6.
  6. Cortes JE, Talpaz M, Kantarjian H (1996). Chronic myelogenous leukemia: a review. Am J Med, 100, 555-70.
  7. Druker BJ, Guilhot F, O'Brien SG, et al (2006): Five-year follow-up of patients receiving imatinib for chronic myeloid leukemia. N Engl J Med, 355, 2408-2417.
  8. European Medicines Agency (EMEA) European public assessment report (EPAR) Glivec: EPAR summary for the public (2009). EMEA/H/C, 406, 3.
  9. Hasford J, Pfirrmann M, Hehlmann R, et al (1998). A new prognostic score for survival of patients with chronic myeloid leukemia treated with interferon alfa. Writing Committee for the Collaborative CML Prognostic Factors Project Group. J Natl Cancer Inst, 90, 850-8.
  10. Hehlmann R, Berger U, Pfirrmann M, et al (2003). Randomized comparison of interferon alpha and HU with HU monotherapy in chronic myeloid leukemia (CML-study II): prolongation of survival by the combination of interferon alpha and HU. Leukemia, 17, 1529-37.
  11. Henkes M, van der Kuip H, Aulitzky WE (2008). Therapeutic options for chronic myeloid leukemia: focus on imatinib (Glivec, Gleevectrade mark). Ther Clin Risk Manag, 4, 163-87.
  12. Hochhaus A, O'Brien SG, Guilhot F, et al (2009). Six-year follow-up of patients receiving imatinib for the first-line treatment of chronic myeloid leukemia. Leukemia, 23, 105-61.
  13. Sinha SK, Sinha S, Mandal PK, et al (2013). A comparative study of Hasford score and Sokal index in prognostication of the novo chronic myeloid leukemia patients and a search for new prognostic markers. Indian J Pathol Microbiol, 56, 216-20.
  14. Irfan SM, Bhurgri Y (2009). Clinico-pathological features and outcomes in chronic phase chronic myeloid leukemia patients treated with HU. Asian Pac J Cancer Prev, 10, 591-4.
  15. Jain P, Das VN, Ranjan A, et al (2013). Comparative study for the efficacy, safety and quality of life in patients of chronic myeloid leukemia treated with Imatinib or HU. J Res Pharm Pract, 2, 156-61.
  16. Menzin J, Lang K, Earle CC, et al (2004). Treatment patterns, outcomes and costs among elderly patients with chronic myeloid leukaemia: a population-based analysis. Drugs Aging, 2, 737-46.
  17. Ohnishi K, Ohno R, Tomonaga M, et al (1995). The Kouseisho Leukemia Study Group. A randomized trial comparing interferon-alpha with busulfan for newly diagnosed chronic myelogenous leukemia in chronic phase. Blood, 86, 906-916.
  18. Oguz FS, Kalayoglu S, Diler AS, et al (2003). HLA system affects the age-at-onset in chronic myeloid leukemia. Am J Hematol, 73, 256-62.
  19. Payandeh M, Sadeghi E, Khodarahmi R, et al (2014). Appearance and disappearance of chronic myeloid leukemia (cml) in patient with chronic lymphocytic leukemia (CLL). Int J Hematol Oncol Stem Cell Res, 8, 49-53.
  20. Payandeh M, Sadeghi E, Sadeghi M (2015). Non-hematological adverse events of imatinib in patients with chronic myeloid leukemia in chronic phase (CML-CP). J App Pharm Sci, 5, 87-90.
  21. Pulte D, Barnes B, Jansen L, et al (2013). Population level survival of patients with chronic myelocytic leukemia in Germany compared to the US in the early 21st century. J Hematol Oncol, 6, 70.
  22. Redaelli A, Bell C, Casagrande J, et al (2004). Clinical and epidemiologic burden of chronic myelogenous leukemia. Expert Rev Anticancer Ther, 4, 85-96.
  23. Rohrbacher M, Hasford J (2009). Epidemiology of chronic myeloid leukaemia (CML). Best Pract Res Clin Haematol, 22, 295-302.
  24. Sinha SK, Sinha S, Mandal PK, et al (2013). A comparative study of Hasford score and Sokal index in prognostication of the novo chronic myeloid leukemia patients and a search for new prognostic markers. Indian J Pathol Microbiol, 56, 216-20.
  25. Sokal JE, Cox EB, Baccarani M, et al (1984). Prognostic discrimination in "good-risk" chronic granulocytic leukemia. Blood, 63, 789-99.
  26. Usman M, Syed NN, Kakepoto GN, et al (2007). Chronic phase chronic myeloid leukemia: response of imatinib mesylate and significance of Sokal score, age and disease duration in predicting the hematological and cytogenetic response. J Assoc Physicians India, 55, 103-7.
  27. Usmani SZ, Yunus SA, Jamal Y (2009). Overview of chronic myeloid leukemia patients in Pakistan in the pre-imatanib era. Asian Pac J Cancer Prev, 10, 1039-40.

Cited by

  1. Diagnosis and Monitoring of Chronic Myeloid Leukemia: Chiang Mai University Experience vol.17, pp.4, 2016,
  2. Use patterns of first-line inhibitors of tyrosine kinase and time to change to second-line therapy in chronic myeloid leukemia vol.39, pp.4, 2017,