Outcome of Imatinib Treatment in Yemeni Patients With Chronic Myeloid Leukemia and the Influence of Nonadherence to Treatment and Duration of Previous Hydroxyurea Therapy.

BACKGROUND: In a developing country like Yemen, data are limited regarding the outcome of imatinib treatment of chronic myeloid leukemia and the effect of nonadherence to imatinib treatment and previous duration of hydroxyurea treatment. PATIENTS AND METHODS: A longitudinal cohort study, which included 164 Yemeni patients, was performed. Data regarding the disease characteristics, adherence to treatment (the medication possession ratio) and outcome were analyzed. RESULTS: After a median follow-up of 60 months and a median duration of imatinib treatment of 46 months, 79 (48.2%) patients were adherent to treatment. In adherent patients, the overall survival and progression-free survival (PFS) were 78 (98.7%) and 73 patients (92.4%), respectively and major molecular response (MMR) rates at 12 months and at 46 months were 32 (41.0%) and 45 patients (57.0%), respectively, compared with 67 (78.8%), 51 (60%), 5 (6.9%), and 2 patients (2.4%), respectively, in nonadherent patients (P < .001 for all parameters). Nonadherence to imatinib treatment and duration of hydroxyurea treatment of more than 12 months before starting imatinib were found to adversely affect PFS in univariate (hazard ratio [HR], 7.5 and 9.7, respectively and P < .001 for both) and multivariate (HR, 5.6 and 9.3; P = .001 and P < .001, respectively) analysis. High risk Sokal score was found to adversely affect PFS in univariate analysis (HR of high to low risk, 2.8; P < .022) but not in multivariate analysis. CONCLUSION: Yemeni patients who were adherent to imatinib therapy achieved response rates similar to that of international standards. Nonadherence to imatinib treatment and previous duration of hydroxyurea treatment for more than 12 months, as a proxy of long interval between diagnosis and starting imatinib treatment, reduced the optimal response to imatinib therapy.

Hematological Characteristics of Yemeni Adults and Children with Visceral Leishmaniasis. Could Eosinopenia be a Suspicion Index?

BACKGROUND AND OBJECTIVES: Delay in the diagnosis of visceral leishmaniasis (VL) particularly in non-endemic areas is associated with higher mortality. In our experience, we found that marked bone marrow eosinopenia was a very frequent accompaniment of VL and might be a useful clue for the diagnosis, which indicates the opportunity for further morphological assessment. The aim of this study was to describe the hematological characteristics including peripheral blood and bone marrow findings of Yemeni adults and children with VL. METHODS: We conducted a descriptive analytic study to evaluate systematically peripheral blood and bone marrow findings of Yemeni adults and children with VL. Peripheral blood and bone marrow aspiration of patients with bone marrow aspirate confirmed VL were examined. Forty-seven patients with the main age (±SD) of 17.34±11.37 years (Range: 1-60) were included in the study. Fifty-one non-VL subjects with splenomegaly and pancytopenia or bicytopenia served as control group. RESULTS: All patients with VL had anemia, 41 (87%) leukopenia, 42 (89%) neutropenia, 44 (94%) thrombocytopenia, 42 (89%) eosinopenia, 34 (72%) pancytopenia and 13 (28%) had bicytopenia. In bone marrow examination 40 (85%) showed hypercellularity, 44 (94%) eosinopenia, 24 (51%) dyserythropoiesis, 22 (47%) lymphocytosis, 8 (17%) plasmacytosis, 27 (57%) decreased iron stores and 20 (43%) showed decreased sideroblasts. Comparison of VL patients with the control group showed significantly more frequent peripheral blood eosinopenia and lymphopenia and marrow eosinopenia. There was no significant difference between adults and children in any of the hematological features. CONCLUSION: Anemia, leukopenia, neutropenia, thrombocytopenia, eosinopenia, pancytopenia and marked bone marrow eosinopenia were the most common findings. The finding of marked bone marrow eosinopenia is a significant clue for the diagnosis of visceral leishmaniasis in patients who present with splenomegaly associated with cytopenias. This finding is particularly valuable in non-endemic areas.

The clinical and biochemical characteristics of Yemeni adults and children with visceral leishmaniasis and the differences between them: a prospective cross-sectional study before and after treatment.

OBJECTIVES: To determine the clinical and biochemical characteristics of Yemeni adults and children with visceral leishmaniasis (VL) and the differences between them. METHODS: A prospective cross-sectional study on patients with bone marrow aspirate confirmed VL evaluated at Al-Jomhori Teaching Hospital in Sana'a, Yemen. RESULTS: Twenty-eight (59.6%) patients were adults with a mean age (± SD) of 24.3 years ± 9.2 and 19 (40.4%) patients were children with a mean age (± SD) of 7.1 years ± 4.7. Fever, pallor, splenomegaly and hepatomegaly were the most common clinical findings. Hypoalbuminaemia, hyperglobulinaemia, elevated LDH, hypocalcaemia and elevated CRP were common biochemical abnormalities. There was no significant difference in splenomegaly size or biochemical parameters with regard to grade of parasitic load. Both children and adults showed similar significant improvement after treatment. CONCLUSION: Biochemical abnormalities were not related to degree of parasitic load and there were no clinical, biochemical or treatment differences between adults and children.

Catha Edulis (Khat) Chewing Decreases Serum Levels of Iron, Ferritin and Vitamin B12 and Increases Folic Acid.

BACKGROUND: Catha edulis (Khat) is customarily chewed to attain a state of stimulation and reduce physical fatigue. In view of the reported common adverse effects of Khat, the aim of this study was to evaluate the levels of iron, ferritin, folic acid, vitamin B(12) and body mass index (BMI) as nutritive indicators in Yemeni Khat chewers. METHODS: This study was a prospective cohort study, carried out on 90 male workers aged 19 - 23 years old; 45 were healthy non-Khat chewers serving as control group and 45 were regular Khat chewers. Serum iron, ferritin, folic acid, vitamin B(12) and body mass index were measured at baseline and after a year of follow up. RESULTS: Serum iron and BMI were significantly (p < 0.01) lower at baseline in Khat chewers by 9 % and 6 %, respectively; whereas ferritin, folic acid and vitamin B(12) were non-significantly different from non-Khat chewers. In the follow-up one year later, serum iron, ferritin, vitamin B(12) and BMI were significantly (p < 0.001) lower in Khat chewers by 19.0, 31.4, 20.6 and 10.7 %; whereas folic acid was significantly (p = 0.007) higher by 26.7 %. Comparison within groups showed serum iron, ferritin, and BMI to be significantly (p < 0.01) decreased after one year in the Khat chewers with respect to its baseline; whereas folic acid significantly (p < 0.001) increased. CONCLUSION: This study shows Khat chewers to be more susceptible to malnutrition, which should be considered by the general population and the public health authorities.

Characteristics of sickle cell anemia in Yemen.

We studied 136 males and 105 females with sickle cell anemia to determine the characteristics of the disease in Yemen. Their mean age [± SD (standard deviation)] was 12.8 ± 9.5 years (range: 9 months-40 years). Taiz, Hudaydah and Hajjah governorates, in the South-Central and the Northwestern provinces, showed the highest prevalence. Eighty percent of the patients had family history of the disease, 73.0% patients had history of parental consanguinity and 20.7% of death of relative(s) due to the disease; 5.4% patients were older than 30 years of age. Pain, jaundice and infection were the most frequent features. Splenomegaly, cholelithiasis, osteomyelitis, acute chest syndrome (ACS), osteonecrosis and stroke occurred in 12.0, 9.5, 8.7, 6.6, 6.6 and 2.9%, respectively. Priapism and leg ulcers were rare. The mean laboratory values (obtained in the steady state) were: hemoglobin (Hb) 7.9 g/dL, WBC 14.08 × 10(9)/L, platelet 460 × 10(9)/L, reticulocytes 14.5%, lactate dehydrogenase (LDH) 597 U/L, Hb F (α2γ2) 16.69%, Hb S [ß6(A3)Glu→Val, GAG>GTG] 77.31% and Hb A(2) (α2δ2) 1.47%, respectively. There was no significant difference between South-Central and Northwestern provinces regarding clinical events and hematological parameters.

Cyclosporine monotherapy for severe aplastic anemia: a developing country experience.

BACKGROUND: Immunosuppression is the most effective treatment for aplastic anemia after hematopoietic stem cell transplantation. Although the combination of cyclosporine and antithymocyte globulin (ATG) is superior to either agent alone, cyclosporine monotherapy is an easily available, safe and cheap immunosuppressive therapy (IST) option. These advantages are particularly valuable in developing countries where ATG is frequently not available. PATIENTS AND METHODS: In the referral hematology center in Yemen, 20 patients (16 males and 4 females) with severe aplastic anemia (SAA) were prospectively identified and managed with cyclosporine monotherapy during the period between April 2001 and November 2004. RESULTS: Data from 14 patients who received cyclosporine for at least 3 months were analyzed. At 6 months, 2 (14.3%) patients achieved complete remission (CR) and 5 (35.7%) patients achieved partial remission (PR) and at 1 year, 4 (28.6%) patients achieved CR and 3 (21.4%) patients remained in PR. The overall response rate was 50% and the cumulative survival rate at 1 year was 78.6%. The median time to remission was 120 days (range, 46 to 131 days). Side effects were modest and easily monitored. CONCLUSION: Our results support findings that cyclosporine monotherapy is an effective and safe immunosuppressive therapy for SAA, and that it could be a reasonable IST option for patients in developing countries.