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Maye JA, Baker O, Sheikh N. Resolution of gastric antral vascular ectasia following cessation of imatinib. BMJ Case Rep 2024; 17:e257620. [PMID: 38388203 PMCID: PMC10884209 DOI: 10.1136/bcr-2023-257620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
A female patient in her 80s presented with chronic iron-deficiency anaemia secondary to gastric antral vascular ectasia (GAVE), despite repeated endoscopic treatment. Her medical history was notable for chronic myeloid leukaemia, for which she took imatinib. Due to a possible association between imatinib and GAVE described in a small number of case reports, cessation of imatinib was trialled. This led to a significant improvement in the patient's anaemia and resolution of GAVE on repeat endoscopy. GAVE is an uncommon cause of gastrointestinal bleeding, the aetiology of which is uncertain. This report describes an approach to the differential diagnosis of chronic iron-deficiency anaemia and an overview of GAVE syndrome. It illustrates the benefit of broadening the differential when the diagnosis is uncertain and the utility of case reports in informing the differential diagnosis.
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Affiliation(s)
- James A Maye
- Medicine, West Suffolk Hospital, Bury Saint Edmunds, UK
| | - Olivia Baker
- Medicine, West Suffolk Hospital, Bury Saint Edmunds, UK
| | - Nadim Sheikh
- Gastroenterology, West Suffolk Hospital, Bury Saint Edmunds, UK
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Puteh SEW, Selamat EM, Aizuddin AN, Tumian NR, Sathar J. Inequality in Drug Utilization among Chronic Myeloid Leukaemia Patients in Malaysia: A Cost-Utility Analysis. Asian Pac J Cancer Prev 2022; 23:4253-4260. [PMID: 36580008 PMCID: PMC9971449 DOI: 10.31557/apjcp.2022.23.12.4253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The burden of chronic myeloid leukaemia (CML) is increasing due to longer patient survival, better life expectancy of the general population, and increasing drug prices. Funding is one of the main concerns in the choice of CML medication used worldwide; thus, patient assistance programmes were introduced to ensure accessibility to affordable treatment. In this study, we evaluated CML drug distribution inequality in Malaysia through patient assistance programmes, using pharmaco-economics methods to evaluate CML treatment from the care provider's perspective. METHODS Patients with CML were recruited from outpatient haematological clinics at the national centre of intervention and referral for haematological conditions and a public teaching hospital. The health-related quality of life or utility scores were derived using the EuroQol EQ-5D-5L questionnaire. Costing data were obtained from the Ministry of Health Malaysia Casemix MalaysianDRG. Imatinib and nilotinib drug costs were obtained from the administration of the participating hospitals and pharmaceutical company. RESULTS Of the 221 respondents in this study, 68.8% were imatinib users. The total care provider cost for CML treatment was USD23,014.40 for imatinib and USD43,442.69 for nilotinib. The governmental financial assistance programme reduced the total care provider cost to USD13,693.51 for imatinib and USD19,193.45 for nilotinib. The quality-adjusted life years (QALYs) were 17.87 and 20.91 per imatinib and nilotinib user, respectively. Nilotinib had a higher drug cost than imatinib, yet its users had better life expectancy, utility score, and QALYs. Imatinib yielded the lowest cost per QALYs at USD766.29. CONCLUSION Overall, imatinib is more cost-effective than nilotinib for treating CML in Malaysia from the care provider's perspective. The findings demonstrate the importance of cancer drug funding assistance for ensuring that the appropriate treatments are accessible and affordable and that patients with cancer use and benefit from such patient assistance programmes. To establish effective health expenditure, drug distribution inequality should be addressed.
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Affiliation(s)
- Sharifa Ezat Wan Puteh
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia. ,For Correspondence: ,
| | - Ellyana Mohamad Selamat
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia. ,For Correspondence: ,
| | - Azimatun Noor Aizuddin
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
| | - Nor Rafeah Tumian
- Department of Medicine, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia.
| | - Jameela Sathar
- Department of Haematology, Hospital Ampang, Ministry of Health Malaysia, Kuala Lumpur, Malaysia.
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Ugwu NI, Okoye AE, Ugwu CN, Ibiam FA, Nnachi OA, Ugwu GC, Okoh NU. Chronic Myeloid Leukaemia with Sudden Bilateral Deafness and Leg Ulcer Associated with Hydroxyurea Therapy. West Afr J Med 2021; 38:502-506. [PMID: 34051725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Deafness occurs rarely in patients with chronic myeloid leukaemia. Hydroxyurea-induced leg ulcer has been found in patients on long-term hydroxyurea therapy. We present a 53 year old man who developed spontaneous bilateral deafness shortly after he was diagnosed with chronic myeloid leukaemia and subsequently developed hydroxyurea induced leg ulcer in the course of treatment. A 53 year-old male presented to our clinic with six months history of left abdominal mass, associated with easy satiety, occasional fever, night sweats, loss of appetite, weight loss, easy fatiguability and bilateral leg swelling. Physical examination showed a middle-aged man in no obvious distress, afebrile, anicteric, pale, with no peripheral lympadenopathy but had bilateral pitting pedal edema to the lower third. There was no significant finding on the chest. Abdominal examination showed hepatosplenomagaly. Full blood count showed anaemia, hyperleucocytosis and thrombocytosis. Peripheral blood film and bone marrow aspiration examinations were in keeping with chronic myeloid leukaemia. The BCR/ABL-1 transcript was negative, thus he was started on hydroxyurea in addition to other supportive treatment. Before commencement of hydroxyurea therapy, he spontaneously developed bilateral sensorineural deafness. Subsequently, he also developed leg ulcers, having been on hydroxyurea therapy for seven years which healed within eight weeks on discontinuation of hydroxyurea. Spontaneous deafness can occur in patients with chronic myeloid leukaemia due to hyperleucocytosis and urgent cytoreduction may help to prevent this complication. In addition, leg ulcer due to long-term hydroxyurea therapy can occur and usually do not respond to the conventional treatment but discontinuation of hydroxyurea.
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Affiliation(s)
- N I Ugwu
- Department of Haematology & Immunology, Faculty of Clinical Medicine, College of Health Sciences, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
| | - A E Okoye
- Department of Haematology & Immunology, Faculty of Clinical Medicine, College of Health Sciences, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
| | - C N Ugwu
- Department of Haematology & Immunology, Faculty of Clinical Medicine, College of Health Sciences, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
| | - F A Ibiam
- Department of Otorhinolaryngology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - O A Nnachi
- Department of Haematology and Transfusion Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - G C Ugwu
- Department of Haematology and Transfusion Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - N U Okoh
- Department of Internal Medicine, Faculty of Clinical Medicine, College of Health Sciences, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
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Annuar AA, Ankathil R, Mohd Yunus N, Husin A, Ab Rajab NS, Abdul Aziz AA, Ibrahim MI, Sulong S. Impact of Fas/Fasl Gene Polymorphisms on Susceptibility Risk and Imatinib Mesylate Treatment Response in Chronic Myeloid Leukaemia Patients. Asian Pac J Cancer Prev 2021; 22:565-571. [PMID: 33639675 PMCID: PMC8190357 DOI: 10.31557/apjcp.2021.22.2.565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Indexed: 12/03/2022] Open
Abstract
Background: The FAS mediated apoptosis pathway involving the FAS and FASL genes plays a crucial role in the regulation of apoptotic cell death and imatinib mesylate (IM) mechanism of action. Promoter polymorphisms FAS-670 A>G and FAS-844 T>C which alter the transcriptional activity of these genes may grant a risk to develop cancer and revamp the drug activities towards the cancer cell. We investigated the association of these two polymorphisms with the susceptibility risk and IM treatment response in Malaysian chronic myeloid leukaemia (CML) patients. Methods: This is a retrospective study, which included 93 CML patients and 98 controls. The polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) method was used to genotype the FAS and FASL polymorphisms. Data nanlysis was done using SPSS Version 22. The associations of the genotypes with susceptibility risk and IM response in CML patients were assessed by means of logistic regression analysis and deriving odds ratio with 95% CI. Results: We observed a significant association between FASL-844T>C polymorphism and CML susceptibility risk and IM response. Variant C allele and FASL-844 CC variant genotype carriers had significantly higher risk for CML susceptibility (OR 1.756, CI 1.163-2.652, p=0.007 and OR 2.261, CI 1.013-5.047, p=0.047 respectively). Conversely, the heterozygous genotype FASL-844 TC conferred lower risk for CML susceptibility (OR 0.379, CI 0.176-0.816, p=0.013). The heterozygous and homozygous variant genotypes and variant C alleles were found to confer a lower risk for the development of IM resistance with OR 0.129 (95% CI: 0.034-0.489 p=0.003), OR 0.257 (95% CI: 0.081-0.818, p=0.021), and OR 0.486 (95% CI: 0.262-0.899, p=0.021) respectively. We also found that FAS-670 A>G polymorphism was not associated with CML susceptibility risk or IM response. Conclusion: The genetic polymorphism FASL-844 T>C may contribute to the CML susceptibility risk and also IM treatment response in CML patients. Accodringly, it may be useful as a biomarker for predicting CML susceptibility risk and IM resistance.
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Affiliation(s)
- Aziati Azwari Annuar
- Human Genome Centre, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Ravindran Ankathil
- Human Genome Centre, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Nazihah Mohd Yunus
- Human Genome Centre, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Azlan Husin
- Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan Malaysia
| | - Nur Shafawati Ab Rajab
- Human Genome Centre, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Ahmad Aizat Abdul Aziz
- Human Genome Centre, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Mohd Ismail Ibrahim
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Sarina Sulong
- Human Genome Centre, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
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Tabassum N, Saboor M, Ghani R, Moinuddin M. Heterogeneity of BCR-ABL rearrangement in patients with chronic myeloid leukemia in Pakistan. Pak J Med Sci 2014; 30:850-3. [PMID: 25097530 PMCID: PMC4121711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 03/25/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Breakpoint cluster region-Abelson (BCR-ABL) rearrangement or Philadelphia (Ph) chromosome in Chronic Myeloid Leukemia (CML) is derived from a reciprocal chromosomal translocation between ABL gene on chromosome 9 and BCR gene on chromosome 22. This chimeric protein has various sizes and therefore different clinical behaviour. The purpose of this study was to determine the heterogeneity of BCR-ABL rearrangement in patients with Ph(+)CML in Pakistan. METHODS The study was conducted at Civil Hospital and Baqai Institute of Hematology (BIH) Karachi. Blood samples from 25 patients with CML were collected. Multiplex reverse transcription polymerase chain reaction (RT-PCR) was performed to identify various BCR-ABL transcripts. RESULTS All 25 samples showed BCR-ABL rearrangements. Out of these, 24 (96%) patients expressed p210 BCR-ABL rearrangements i.e. 60% (n=15) had b3a2 and 32% (n=8) had b2a2 rearrangements. Co-expression of b3a2 /b2a2 rearrangement and p190 (e1a3) rearrangement was also identified in two patients. CONCLUSION It is apparent that majority of the patients had p210 BCR-ABL rearrangements. Frequency of co-expression and rare fusion transcripts was very low.
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Affiliation(s)
- Najia Tabassum
- Najia Tabassum, M.Phil, Baqai Institute of Hematology, Baqai Medical University, Karachi, Pakistan
| | - Mohammad Saboor
- Mohammed Saboor, PhD, Baqai Institute of Hematology, Baqai Medical University, Karachi, Pakistan
| | - Rubina Ghani
- Rubina Ghani. PhD, Department of Biochemistry, Baqai Medical University, Karachi, Pakistan
| | - Moinuddin Moinuddin
- Moinuddin Moinuddin, FRCP (E), FRCP (C), Baqai Institute of Hematology, Baqai Medical University, Karachi, Pakistan
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Radhika N, Minakshi M, Rajesh M, Manas BR, Deepak Kumar M. Central nervous system blast crisis in chronic myeloid leukemia on imatinib mesylate therapy: report of two cases. Indian J Hematol Blood Transfus 2011; 27:51-4. [PMID: 22379297 DOI: 10.1007/s12288-011-0055-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 01/25/2011] [Indexed: 11/30/2022] Open
Abstract
Chronic myeloid leukaemia is a chronic myeloproliferative disorder characterised by a reciprocal translocation between chromosomes 9 and 22 and thereby formation of the Philadelphia chromosome. Imatinib mesylate (STI-571) is a potent and selective inhibitor of BCR-ABL tyrosine kinase and has emerged as a treatment of choice in chronic myeloid leukaemia (CML) patients in chronic phase. It has shown activity in CML patients in the chronic phase or blastic phase. However there is poor penetration of the central nervous system (CNS) by the drug or its active metabolites. Therefore the CNS acts as a sanctuary site for malignant cells for CML patients treated with Imatinib. We report cases of two CML patients on Imatinib therapy, who were in haematological remission but developed CNS disease.
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Affiliation(s)
- Narayan Radhika
- Department of Pathology, Tata Main Hospital, Jamshedpur, 831001 Jharkhand India
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