Imatinib in chronic myeloid leukemia: patient-reported side effects and their influence on quality of life

Objective: To evaluate side effects of Imatinib by patients of chronic myeloid leukemia and their influence on quality of life. Study Design: Descriptive and analytic study. Place and Duration of Study: The study was carried out at department of oncology CMH Rawalpindi, from Jan 2015 to Dec 2015

Material and Methods: The study was carried out at department of oncology CMH Rawalpindi from Jan 2015 to Dec 2015. Patients who had been using Imatinib orally for at least 6 months participated in the study. Patients under 18 years of age were excluded from the study. A questionnaire was developed to record adverse effects. This questionnaire included demographic details and quality of life issues like effects on their mood, daily life activities, work, walking and relationships

Results: Ninety two patients participated in the study. Mean age of the participants was 42.05 years [range 22 to 68 years], 52% were males. Among the study population eighty-seven percent had suffered from at least one adverse reaction. The most commonly complained adverse events were muscle cramps [67 out of 92, 72.8%]; fatigue [58 out of 92 63.04%], gastro intestinal upset [44 out of 92 47.82%] and skin rashes [30 out of 92 32.60%]. More than half of the patients felt that the adverse effect had a negative influence on their daily quality of life

Conclusion: Adverse drug effects were common among CML patients receiving Imatinib therapy. These adverse drug reactions had negative impact on patients' daily life

Early molecular response with Imatinib therapy in chronic Myeloid Leukemia and its association with baseline white blood cell count and Spleen size

Objectives: To determine the frequency of early molecular response in patients of chronic myeloid leukemia treated with Imatinib and its association with baseline white blood cell [WBC] count and spleen size

Study Design: Cross sectional study

Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, from May to Nov 2017

Material and Methods: Seventy eight patients of Chronic Myeloid Leukemia [CML] in chronic phase [CP] were included in the study. Inclusion criteria were: 18 years or older, diagnosed with CML in CP with positive BCR ABL1. Patients who were in accelerated/blast phase, or already taking any Tyrosine Kinase Inhibitors or chemotherapy were excluded from the study. Base line WBC count, spleen size and BCR-ABL1 is values were recorded. All the enrolled patients were placed on Imatinib therapy [400 mg/day] and RT-PCR for BCR ABL1 transcript was repeated after three months

Results: In our study, 60.15 percent of patients achieved EMR at 3 months after Imatanib therapy [p-value <0.001]. In univariate analysis, there was significant association of spleen size, baseline WBC count and percentages of blasts in bone marrow with BCR ABL1 [IS] at 3 months [p-value <0.001], while on multivariate regression model, significant association was found only in spleen size [p-value <0.001] with EMR

Conclusion: A significant number of patients achieved EMR with Imatinib therapy. Spleen size at diagnosis was the only significant factor associated with achieving EMR. It is imperative to identify patients at an early stage who are unlikely to achieve EMR and therefore have poor over-all survival

Early asymptomatic decline in left ventricular ejection fraction in adult cancer patients receiving doxorubicin

To determine the frequency of doxorubicin induced early asymptomatic decline in left ventricular ejection fraction by serial echocardiography and to identify risk factors associated with cardiotoxicity. Quasi-experimental study. Oncology Department, Combined Military Hospital, Rawalpindi from January 2012 to December 2012. Patients who were started on doxorubicin-based chemotherapy during the study period and had completed at least 300 mg/m[2] cumulative dose were included in this study. Electrocardiography, chest X-ray and echocardiography were done at baseline and one to three months after completion of chemotherapy. All patients were evaluated for the presence of the following risk factors: pre-existing coronary artery disease, diabetes mellitus, hypertension, chest wall irradiation and a cumulative dose exceeding 400 mg/m[2]. Asymptomatic cardiac dysfunction was defined as ejection fraction [EF] fall greater than 10% on follow-up echocardiography with minimum or no symptoms. Significant change was observed in ejection fraction after completion of chemotherapy. Out of 54 patients, 27.8% showed 5%, 13% showed 10% decline, 16.7% had 15% decline, one [1.9%] patient had 20% decline in EF after completion of chemotherapy while 40.7% had no change in ejection fraction. Thirty one percent of the patients developed > 10% decline, in left ventricular ejection fraction with the use of doxorubicin in the cumulative dose range of 300-400 mg/m[2]. Pre-existing coronary artery disease, hypertension and a cumulative dose exceeding 400 mg/m[2] are identifiable risk factors in this study. This entails regular monitoring for cardiac dysfunction by echocardiography during doxorubicin treatment

Frequency and severity of neutropenia in diffuse large beta-cell non Hodgkin's lymphoma after first cycle of chemotherapy comprising cyclophosphamide, doxorubicin, vincristine with prednisolone

Chemotherapy used for malignant diseases may produce severe neutropenia in first cycle which may compel for dose modification and early termination of therapy. This descriptive cross sectional study was planned to see the frequency and severity of neutropenia after first cycle of chemotherapy comprising cyclophosphamide, doxorubicin, vincristine with prednisolon in patients of diffuse large B-cell non Hodgkin's lymphoma presenting at Oncology Department Combined Military Hospital Rawalpindi from August 2009 to July 2010. Thirty patients of diffuse large B-cell non Hodgkin's lymphoma diagnosed on lymph node biopsy presenting for the first time at Oncology Department Combined Military Hospital Rawalpindi were included. They were admitted in the ward and evaluated with history, physical examination and staging investigations. Patients were then planned for first cycle of chemotherapy comprising cyclophosphamide, doxorubicin, and vincristine with prednisolon. After the first cycle of chemotherapy they were monitored for expected neutropenia in the ward. The neutrophil counts were repeated on days 7 and 10 following chemotherapy. Neutropenia was graded as defined in the operational definition and all the data was entered on a specially designed data card. As much as 3.3% of patients suffered from grade IV neutropenia [absolute neutrophil count of <0.5x10[9]/L], 3.3% had grade III neutropenia [absolute neutrophil count of 0.5x10[9]/L- 0.9x10[9]/L], 6.6% had Grade II neutropenia [absolute neutrophil count 1.0x10[9]/L-1.4x10[9]/L and 10% had Grade I neutropenia [absolute neutrophil count 1.5x10[9]/L-1.9x10[9]/L. Overall 23.2% suffered from neutropenia of all grades post 1st cycle of chemotherapy comprising cyclophosphamide, doxorubicin, vincristine with prednisolon in diffuse large B-cell non Hodgkin's lymphoma. Further studies are required to find the risk factors to predict this complication in our population

Smoking among doctors of military hospital Rawalpini; frequency habits and attitudes

To know the frequency of smoking habit among doctors of Military Hospital Rawalpindi and to know their attitudes towards it .Questionnaire based descriptive study. The study was conducted at Department of Medicine, Military Hospital, Rawalpindi from December 2004 to May 2005. 106 doctors from Military Hospital, Rawalpindi were included either by direct interviews or by filling of questionnaire by the participants. Smokers, all male, were 18 [17% of responders]. Mean age of starting smoking was 19.4 years. Average number of cigarettes smoked per day was 12.6. Among smokers 11 [61.1%] were not willing to quit smoking. A majority of non-smoker doctors considered themselves as role models and agreed that smoking at public places should be prohibited. Smoking among doctors in this study is not high however there is less willingness to combat smoking habits of patients in doctors who smoke. A continuing education program should be instituted to motivate doctors about their role in society