Clinical presentations and ten-year follow-up of chronic myeloid leukemia patients receiving imatinib in Iraqi Kurdistan

BACKGROUND: Chronic myeloid leukemia (CML) is driven by the BCR–ABL fusion gene, a constitutively active tyrosine kinase that can be effectively targeted with tyrosine kinase inhibitors (TKIs), particularly imatinib. Long-term real-world data on the effectiveness and safety of imatinib in low-resource settings remain limited. OBJECTIVES: The aims was to evaluate the ten-year clinical outcomes, treatment responses, and tolerability of imatinib in CML patients in Iraqi Kurdistan. MATERIALS AND METHODS: A retrospective cross-sectional study involved 160 patients with CML using recorded hospital data from three different hematology centers in Iraqi Kurdistan, from 2014 to 2024. Collected data included patients’ sociodemographic, clinical presentation, blood parameters, blood film, bone marrow examination, response to therapy, and survival rate. Then, they were analyzed and interpreted. RESULTS: Most patients were females (51.25%), from Sulaimaniyah city (55%), aged 40–49 years old (27%), diagnosed between 2020 and 2024 (43%), and presented with fatigue (50%). Blood tests indicated low hemoglobin (<12 mg/dL) with extremely high leukocytes (44%), but normal platelets (66%). The blood film and bone marrow biopsy were abnormal in most patients. Furthermore, P210 expression was higher than P230 (98% vs. 2.0%). All patients received first-line treatment (only imatinib), 49 patients received a second line (mostly nilotinib), and only 7 patients received a third line. Using imatinib for 1–3 years results in resistance development in (26%) of patients and leads to discontinuation of the therapy. Despite several side effects of imatinib (especially anemia), the survival rate was very high (87%). CONCLUSION: Imatinib remains a highly effective frontline therapy for CML in resource-limited settings, demonstrating durable responses and favorable long-term survival despite moderate rates of resistance and side effects.