Diagnosis and Monitoring Response in CML: New Challenge for the iCMLf

During the ASH meeting in 2009 John Goldman and I had the opportunity to meet with Pat Garcia-Gonzalez and Erin Schwartz from the Max Foundation to talk about our common interests. One of the issues that they raised was the lack of diagnostic and monitoring services for CML patients throughout many of the less developed nations.

There are many CML patients who cannot access any therapy (including the GIPAP program) because they can’t afford to have a diagnostic test for the disease. In addition, many patients who are able to access imatinib through the GIPAP program have little or no access to any ongoing monitoring tests to determine their response to therapy. The first sign of loss of response in these patients is often clinical evidence of acute phase disease or hematological relapse. In these settings it is usually too late to derive much benefit from second-line TKI therapy.

We would like to work towards providing diagnostic testing and ultimately disease monitoring for CML patients in developing countries. The question which we are now considering is how we could most efficiently achieve PCR testing (or FISH testing if that is appropriate in some settings) in developing regions. It may be necessary to use different strategies depending on the local conditions such as whether an established PCR laboratory is close by and whether there is local infrastructure and skilled staff that would make it realistic to consider setting up RQ-PCR testing for BCR-ABL. Possible solutions would be to

1. (1) establish high quality testing in the patient centre
2. (2) develop a low cost strategy for sending patient samples to a central laboratory for testing or
3. (3) examine point of care PCR testing.

We invite your comments and suggestions. We need better understanding of the scope of this challenge, what possible solutions we should consider, and what sources of funding we could seek for this project. Please use the web-site forum or email us directly with your thoughts and suggestions. We hope you agree that this should be a very high priority for the Foundation.

Professor Tim Hughes

Royal Adelaide Hospital, Adelaide (Australia)

iCMLf chair