Patients, Borders, Money, and Mission: A Global Perspective of Chronic Myeloid Leukemia

With the easy availability of first, second, and third generation tyrosine kinase inhibitors directed against the bcr/abl gene, the management of the majority of patients of CML in the chronic phase in the developed countries is pretty much ‘cut and dried’. However, for the huge number of patients in the resource-poor countries, optimal management poses several challenges. This session will focus on highlighting some of these challenges and discuss unique issues related to disease diagnosis, optimal management and monitoring, and issues related to making even the first generation TKI available to a section of patients.

Dr. Scott Ramsey will discuss issues related to the introduction of generic imatinib on prescribing patterns, costs, and outcomes for patients with CML, including implications for care as second generation TKI’s become available as generics.

Dr. Hemant Malhotra, through a case-based discussion, will focus on disease characteristics in resource-poor countries, the availability and use of generic imatinib, the challenges with monitoring of CML and the use of some low-cost indigenous interventions for patients who have a sub-optimal response to imatinib and are not candidates for either second or third gen TKIs or Allo SCT.

Dr. Jerald Radich will then discuss the problem of bcr/abl monitoring in areas of the world where there are a large number of CML patients but with no/minimal laboratory facilities for RT-PCR testing. Dr. Radich will highlight innovative ways and means for testing and transporting blood samples which may be applicable and well suited to these under privileged regions of the world.

Finally, in the last talk, Ms. Pat Gracia-Gonzalez will highlight the problem of non-availability of TKI and even basic CML diagnostic facilities in resource-poor countries and the incredible efforts made by the MAX foundation to address some of these issue.