A Review Article on Chronic Myeloid Leukaemia in Nigeria in the Era of Targeted Therapy

Abstract

A Review Article on Chronic Myeloid Leukaemia in Nigeria in the Era of Targeted Therapy Chronic Myelocytic leukaemia is a myeloproliferative neoplasm and the first malignancy to be pathogenically related to an acquired genetic aberration involving reciprocal translocations between the long arms of chromosomes 9 and 22, with generation of the oncogenic BCR-ABL1 gene and the Philadelphia (Ph) chromosome.  CML was incurable in the absence of a successful allogeneic stem cell transplantation that is available to less than 45% of the affected population.  Curative potential came at the turn of the century with the discovery of imatinib, and other tyrosine kinase inhibitors (TKIs) that specifically kill the BCR-ABL1 oncoprotein. Today, survival of CML patients on therapeutic doses of TKI is no different from any other chronic disorder, with life span comparable to those of age-matched healthy controls in the general population. Imatinib targeted therapy has decreased the annual mortality of CML from 10%-20%    to only 1%-2% in the USA between 2000 and 2017; and in Nigeria, the median survival of CML patients has risen from 31.7 months in 2006 to 
176 months in 2021 following introduction of Imatinib in 2003, courtesy of the Max Access Solutions, Seattle, USA. This review summarizes our experience in the management of CML in Nigeria with reference to local and foreign publications through PubMed, Google Scholar and Google, on epidemiology, pathogenesis, diagnosis and differentials; we also considered disease staging, risk factors, treatment evolution and challenges of therapy, including pharmacokinetic studies, cost implications, adherence, host factors, parenting and pregnancy, associated disease(s), and survival.