Tyrosine kinase inhibitors have revolutionized CML treatment but the cost is considered a very big obstacle in developing countries. Taking cost into consideration, is it possible to recommend HSCT instead of TKI for treatment of CML?
in my opinion if HLA matched sibling is available, HSCT is best choice in pediatric patients.
Over the long term, successful HSCT should be cheaper, although Gleevec will soon come off patent, which will make it less expensive.
The cost comparison of HSCT vs TKI is not easy. If you only take the early period of SCT into account, it may seem that SCT is less costly, but if you take the long term consequences into account such as GVHD, late fungal infections, CMV etc, I think that TKI is the first choice, also very favorable in terms of quality of life. The generic TKI's will make this more attractive and HSCT shoul be reserved for resistant pts.
I think TKIs are the 1st choice in the developing countries. HSCT maybe more cost effective on the long run, yet having a successful HSCT without complications in developing countries standard or best hospital even is so difficult and of low percentages. In our institute TKIs are still the 1st choice and I think it would keep so for more time.
I am with Hamdi and Shady, TKIs would be 1st choice in my opinion. A HSCT is not a cheap procedure from an economic point of view neither from a morbi-mortality point of view.
Dear Mohammad,
Thank you for the question, I am sorry that I cant react to you because I am not in the field.
I agree with all colleagues that consider TKI as 1st choice. Patients must understand they have "leukemia" and adhere strictly to treatment. It is important to consider potencial food interactions according to different regions.
to the best of our knowledge, TKIs (specifically imatinib mesylate) is the best choice for treating CML patients since it had been shown to improve the disease free survival and overall survival rate of the patient. regarding the cost, India, one of the developing country is lucky in the sense that the drug is provided to the patients at affordable cost.
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