Kronisk myelogen leukemi ved St. Olavs Hospital 1996-2009
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Background: Most patients with chronic myeloid leukemia (CML) have the Philadelphia chromosome, which arise from a translocation between chromosome 9 and 22. The translocation forms the BCR-ABL fusion gene, which encodes a constitutionally active tyrosine kinase. Today, the recommended initial treatment is tyrosine kinase inhibitors imatinib, nilotinib or dasatinib. Response is assessed with cytogenetics and quantitative polymerase chain reaction. National guidelines aims to ensure optimal follow-up and treatment of the CML patients. The purpose of this student thesis is to look at follow-up and treatment results in CML patients treated at St. Olavs Hospital in the time period 1996-2009. Materials and methods: The study is a retrospective, anonymized systematization of follow-up and treatment results at Avdeling for blodsykdommer, St. Olavs Hospital. The data collection comprised a review of 39 patients records, and the patients were followed in five years from the date of diagnosis. The statistical analysis were carried out by using IBM SPSS statistics 23. Results: Among patients diagnosed in the time period 2003-2009 MR3 at 12 months was obtained in 53,3 %, while the proportion of patients with MR4 at 12 months was 40,0 %. At five years 85,7 % and 57,1 % of the patients had obtained MR3 and MR4, respectively. After 12 months of treatment 80,0 % of the patients were in CCgR, while 20,0 % were in PCgR. Mean CML specific overall survival was 180 months (95 % confidence interval 150-210 months). Mean progression free survival (PFS) was 179 months (95 % confidence interval 148-210 months). Three patients with diagnosis in the time period 2003-2009 died from their leukemia, while seven patients with diagnosis in the time period 1996-2002 died from their leukemia. 13 patients had to switch drug of choice at least once during the five years of follow up, and mean CML survival in these patients was 129 months (95 % confidence interval 76-182). In the patients that continued the initial treatment mean survival was 201 months (95 % confidence interval 169-233 months). Log Rank p = 0,059. Eight of total 39 patients received 5 allo-SCT, and all of these patients got their CML diagnosis in the time period 1996-2002. Interpretation: National guidelines for CML treatment are mainly followed at St. Olavs Hospital. The treatment is effective and in accordance with international treatment results.