Elsevier

Leukemia Research

Volume 34, Issue 11, November 2010, Pages 1459-1471
Leukemia Research

Chronic myeloid leukemia in the Asia-Pacific region: Current practice, challenges and opportunities in the targeted therapy era

https://doi.org/10.1016/j.leukres.2010.03.033Get rights and content

Abstract

Chronic myeloid leukemia (CML) management varies across Asia due to disparities in affluence and healthcare provision. We surveyed CML management practice at 33 hospitals in 14 countries/regions to identify treatment challenges and opportunities for harmonization.

Patients were generally treated according to international guidelines; however, tyrosine kinase inhibitors (TKIs) and molecular monitoring are inaccessible to many patients not covered by national insurance or eligible for subsidized treatment. Late diagnosis and suboptimal monitoring, often due to cost and accessibility issues, are challenges. Priorities for Asia include: extending accessibility to TKIs; specialist laboratory monitoring; and enriching data to support regional CML management guidelines.

Introduction

Chronic myeloid leukemia (CML) is a commonly diagnosed hematologic malignancy in Asia, and appears to have lower median age of onset in Asians than Caucasians [1]. In 2001, the introduction of the first targeted tyrosine kinase inhibitor (TKI), imatinib mesylate (Glivec®; Novartis) revolutionized the therapeutic paradigm and dramatically improved outcomes [2], [3]. Since then, international guidelines that recommend imatinib as first-line therapy for patients at all phases of CML, including those eligible for HSCT [4], [5], [6], [7], have been followed in principle by most countries throughout the Asia-Pacific region. However, wide regional variations in levels of economic development, differences in national healthcare systems and insurance coverage, and disparities in affluence, both within and between countries, have a major influence on individual clinicians’ approaches to CML management in everyday practice, and for these reasons, the CML management algorithm is not uniform across the Asia-Pacific region.

As second-generation TKIs are incorporated into clinical practice, the optimization of CML management for Asian patients has become an even higher priority. For these reasons, the Asia CML Study Alliance (ACSA) developed a comprehensive survey to assess current CML treatment patterns in the Asia-Pacific region in order to identify both knowledge gaps and unmet treatment needs that should be addressed to harmonize the treatment algorithm, as well as opportunities for research to address topics of particular relevance in the region.

Section snippets

ACSA Asia-Pacific CML survey

ACSA designed a questionnaire to survey CML treatment provision and patterns of CML management practice in Asia. Between November 2008 and April 2009, the questionnaire was distributed to specialist physicians treating CML patients at 33 different hospitals in countries/regions across the Asia-Pacific region (Appendix Table A.1).

The survey included both nation-specific questions on insurance coverage of CML therapies and CML research activities, for example, existence of study groups and CML

Survey participants

Respondents from 33 hospitals located in 14 Asia-Pacific countries/regions participated in the ACSA CML survey: Australia (2); China (7); Hong Kong (2); India (2); Indonesia (1); Japan (4); Malaysia (2); New Zealand (1); Philippines (1); Singapore (2); South Korea (1); Taiwan (5); Thailand (2); Vietnam (1). Their main departmental specialties included hematology (7), hematology and HSCT (8), hematology and oncology (14) and medical oncology (4).

Twenty respondents worked exclusively in an

Discussion

This survey of 33 centers across 14 countries/regions provides important insights into current clinical practice in the Asia-Pacific region, and serves as a baseline for future reference to gauge how CML management in the region has progressed or changed.

In considering these findings, we acknowledge certain limitations. The sample was relatively small, and included only one or a few major representative centers in each country. Furthermore, participants were selected because of their active

Conflict of interest

DWK, UB, YTG, PG, HH, SJ, LPK, SCN, JLT are members of Novartis Asia-Pacific CML Advisory Board and have received funding from Novartis for participation in research and clinical trials. II, TN, VP, HR, AT, JW and RW are members of Novartis Asia-Pacific CML Advisory Board. LYS received funding from Novartis for molecular analysis.

Acknowledgements

This work was supported by an unrestricted educational grant from Novartis.

The study sponsor provided advice and feedback on the survey questionnaire. The study sponsor had no involvement in the collection, analysis or interpretation of data. The study sponsor reviewed early drafts of the manuscript and supported the decision publish; however, the authors had complete independence in drafting and approving the final version and in their choice of journal for submission.

The authors would like to

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