A Retrospective Analysis Regarding Comparative Efficacy and Safety of Hyper-CVAD and MEC Chemo-Protocols in Patients with Chronic Myelogenous Leukemia from Lahore, Pakistan

Abstract

Background: Chronic myelogenous leukemia (CML) is potentially curable disease of white blood cells (WBCs) especially granulocytes. Our objective was to evaluate comparative efficacy and safety of two chemotherapy protocols i.e. hyper-CVAD and MEC in patients with CML who were unresponsive to conventional therapies. Methods: A retrospective study was performed among 60 patients with blast crisis phase of myelogenous leukemia (CML) who are the candidates of allogeneic stem cell transplant (ASCT) where half of the patients were treated with hyper-CVAD and half with MEC chemotherapy protocol. Data was analyzed using SPSS (Statistical program for social sciences). Results: Both hyper-CVAD and MEC chemotherapy protocols produced a decrease in neutrophil and platelet count. Blast crisis is also associated with thrombocytopenia. So, these regimens further decrease the platelet count in blast crisis and their efficacy is questionable. Allogenic stem cell transplant is a better option and assessment of its effectiveness may be studied. In case of SGOT and SGPT, hyper-CVAD produced significant elevation whereas MEC effect was variable showing statistically insignificant elevation. Both protocols showed increase in the level of blood urea nitrogen and serum creatinine. In case of efficacy parameters hyper-CVAD showed greater response than MEC protocol. Higher molecular response of 70% was found with hyper-CVAD as compared to 60% of MEC protocol. Cytogenetic response was also higher in hyper-CVAD group. Conclusion: Due to higher efficacy and tolerable toxicity profile of hyper-CVAD chemotherapy protocol, it can be considered as standard therapeutic option whereas MEC chemotherapy protocol can be reserved as an effective alternative in cases where the disease is less aggressive or less tolerable to hyper-CVAD. However, hepatic parameters must not be overlooked while considering any of these protocols and possible adjustments should be made accordingly.