A Ten-Year Experience of Treating Chronic Myeloid Leukemia in Rural Rwanda: Outcomes and Insights for a Changing Landscape Article Swipe
Jennifer Morgan
,
Rebecca DeBoer
,
Jean Bosco Bigirimana
,
Cam Nguyen
,
Déogratias Ruhangaza
,
Alan Paciorek
,
Fred Mugabo
,
Chandler Villaverde
,
Nicaise Nsabimana
,
Pascal Bihizimana
,
Aline Umwizerwa
,
Leslie Lehmann
,
Lawrence N. Shulman
,
Cyprien Shyirambere
·
YOU?
·
· 2022
· Open Access
·
· DOI: https://doi.org/10.1200/go.22.00131
YOU?
·
· 2022
· Open Access
·
· DOI: https://doi.org/10.1200/go.22.00131
PURPOSE In describing our ten-year experience with treating chronic myeloid leukemia (CML) as part of the Glivec Patient Assistance Program (GIPAP) in rural Rwanda, we evaluate (1) patient characteristics and treatment outcomes, (2) resource-adapted management strategies, and (3) the impact of diagnostic capacity development. METHODS We retrospectively reviewed all patients with BCR-ABL–positive CML enrolled in this GIPAP program between 2009 and 2018. Clinical data were analyzed using descriptive statistics, Kaplan-Meier methods, proportional hazards regression, and the Kruskal-Wallis test. RESULTS One hundred twenty-four patients were included. The median age at diagnosis was 34 (range 8-81) years. On imatinib, 91% achieved complete hematologic response (CHR) after a median of 49 days. Seven (6%) and 12 (11%) patients had primary and secondary imatinib resistance, respectively. The 3-year overall survival was 80% (95% CI, 72 to 87) for the cohort, with superior survival in imatinib responders compared with those with primary and secondary resistance. The median time from imatinib initiation to CHR was 59 versus 38 days ( P = .040) before and after in-country diagnostic testing, whereas the median time to diagnosis ( P = .056) and imatinib initiation ( P = .170) was not significantly different. CONCLUSION Coupling molecular diagnostics with affordable access to imatinib within a comprehensive cancer care delivery program is a successful long-term strategy to treat CML in resource-constrained settings. Our patients are younger and have higher rates of imatinib resistance compared with historic cohorts in high-income countries. High imatinib resistance rates highlight the need for access to molecular monitoring, resistance testing, and second-generation tyrosine kinase inhibitors, as well as systems to support drug adherence. Hematologic response is an accurate resource-adapted predictor of survival in this setting. Local diagnostic capacity development has allowed for continuous, timely CML care delivery in Rwanda.
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1200/go.22.00131
- https://ascopubs.org/doi/pdfdirect/10.1200/GO.22.00131?role=tab
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- gold
- Cited By
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- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4285500195
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4285500195Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.1200/go.22.00131Digital Object Identifier
- Title
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A Ten-Year Experience of Treating Chronic Myeloid Leukemia in Rural Rwanda: Outcomes and Insights for a Changing LandscapeWork title
- Type
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articleOpenAlex work type
- Language
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enPrimary language
- Publication year
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2022Year of publication
- Publication date
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2022-07-01Full publication date if available
- Authors
-
Jennifer Morgan, Rebecca DeBoer, Jean Bosco Bigirimana, Cam Nguyen, Déogratias Ruhangaza, Alan Paciorek, Fred Mugabo, Chandler Villaverde, Nicaise Nsabimana, Pascal Bihizimana, Aline Umwizerwa, Leslie Lehmann, Lawrence N. Shulman, Cyprien ShyirambereList of authors in order
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https://doi.org/10.1200/go.22.00131Publisher landing page
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https://ascopubs.org/doi/pdfdirect/10.1200/GO.22.00131?role=tabDirect link to full text PDF
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YesWhether a free full text is available
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-
goldOpen access status per OpenAlex
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https://ascopubs.org/doi/pdfdirect/10.1200/GO.22.00131?role=tabDirect OA link when available
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Myeloid leukemia, Medicine, Geography, Oncology, Internal medicineTop concepts (fields/topics) attached by OpenAlex
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5Total citation count in OpenAlex
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2025: 2, 2024: 1, 2023: 2Per-year citation counts (last 5 years)
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35Number of works referenced by this work
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10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.whereas | 173 |
| abstract_inverted_index.younger | 224 |
| abstract_inverted_index.Clinical | 62 |
| abstract_inverted_index.Coupling | 195 |
| abstract_inverted_index.accurate | 270 |
| abstract_inverted_index.achieved | 98 |
| abstract_inverted_index.analyzed | 65 |
| abstract_inverted_index.capacity | 42, 280 |
| abstract_inverted_index.compared | 142, 232 |
| abstract_inverted_index.complete | 99 |
| abstract_inverted_index.delivery | 208, 289 |
| abstract_inverted_index.enrolled | 53 |
| abstract_inverted_index.evaluate | 25 |
| abstract_inverted_index.historic | 234 |
| abstract_inverted_index.imatinib | 119, 140, 154, 184, 202, 230, 240 |
| abstract_inverted_index.leukemia | 10 |
| abstract_inverted_index.methods, | 70 |
| abstract_inverted_index.patients | 49, 82, 114, 222 |
| abstract_inverted_index.response | 101, 267 |
| abstract_inverted_index.reviewed | 47 |
| abstract_inverted_index.setting. | 277 |
| abstract_inverted_index.strategy | 214 |
| abstract_inverted_index.superior | 137 |
| abstract_inverted_index.survival | 125, 138, 274 |
| abstract_inverted_index.ten-year | 4 |
| abstract_inverted_index.testing, | 172, 252 |
| abstract_inverted_index.treating | 7 |
| abstract_inverted_index.tyrosine | 255 |
| abstract_inverted_index.diagnosis | 89, 178 |
| abstract_inverted_index.highlight | 243 |
| abstract_inverted_index.imatinib, | 96 |
| abstract_inverted_index.included. | 84 |
| abstract_inverted_index.long-term | 213 |
| abstract_inverted_index.molecular | 196, 249 |
| abstract_inverted_index.outcomes, | 31 |
| abstract_inverted_index.predictor | 272 |
| abstract_inverted_index.secondary | 118, 148 |
| abstract_inverted_index.settings. | 220 |
| abstract_inverted_index.treatment | 30 |
| abstract_inverted_index.Assistance | 18 |
| abstract_inverted_index.CONCLUSION | 194 |
| abstract_inverted_index.adherence. | 265 |
| abstract_inverted_index.affordable | 199 |
| abstract_inverted_index.countries. | 238 |
| abstract_inverted_index.describing | 2 |
| abstract_inverted_index.diagnostic | 41, 171, 279 |
| abstract_inverted_index.different. | 193 |
| abstract_inverted_index.experience | 5 |
| abstract_inverted_index.in-country | 170 |
| abstract_inverted_index.initiation | 155, 185 |
| abstract_inverted_index.management | 34 |
| abstract_inverted_index.resistance | 231, 241, 251 |
| abstract_inverted_index.responders | 141 |
| abstract_inverted_index.successful | 212 |
| abstract_inverted_index.Hematologic | 266 |
| abstract_inverted_index.continuous, | 285 |
| abstract_inverted_index.descriptive | 67 |
| abstract_inverted_index.development | 281 |
| abstract_inverted_index.diagnostics | 197 |
| abstract_inverted_index.hematologic | 100 |
| abstract_inverted_index.high-income | 237 |
| abstract_inverted_index.inhibitors, | 257 |
| abstract_inverted_index.monitoring, | 250 |
| abstract_inverted_index.regression, | 73 |
| abstract_inverted_index.resistance, | 120 |
| abstract_inverted_index.resistance. | 149 |
| abstract_inverted_index.statistics, | 68 |
| abstract_inverted_index.strategies, | 35 |
| abstract_inverted_index.twenty-four | 81 |
| abstract_inverted_index.Kaplan-Meier | 69 |
| abstract_inverted_index.development. | 43 |
| abstract_inverted_index.proportional | 71 |
| abstract_inverted_index.comprehensive | 205 |
| abstract_inverted_index.respectively. | 121 |
| abstract_inverted_index.significantly | 192 |
| abstract_inverted_index.Kruskal-Wallis | 76 |
| abstract_inverted_index.characteristics | 28 |
| abstract_inverted_index.retrospectively | 46 |
| abstract_inverted_index.resource-adapted | 33, 271 |
| abstract_inverted_index.second-generation | 254 |
| abstract_inverted_index.BCR-ABL–positive | 51 |
| abstract_inverted_index.resource-constrained | 219 |
| cited_by_percentile_year.max | 97 |
| cited_by_percentile_year.min | 90 |
| corresponding_author_ids | https://openalex.org/A5000962745 |
| countries_distinct_count | 2 |
| institutions_distinct_count | 14 |
| corresponding_institution_ids | https://openalex.org/I4390039329 |
| citation_normalized_percentile.value | 0.74860203 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | False |