International Journal of Hematology

, Volume 95, Issue 5, pp 556–563 | Cite as

Chronic myeloid leukaemia and human immunodeficiency virus (HIV) infection

  • Michael J. Webb
  • Claire L. Barrett
  • Christel Pretorius
  • Magdalena F. van Jaarsveld
  • Vernon J. Louw
Original Article


The occurrence of chronic myeloid leukaemia (CML) in patients infected with the human immunodeficiency virus (HIV) has rarely been reported in the literature. In this report, we describe the experience of a single centre in the management of 10 such patients, including demographic information, disease characteristics and response to therapy. We had a black female predominance in our series, with only a minority of patients achieving a complete cytogenetic response. The main reason for this appears to be compliance, which was influenced by distance to the treating centre. The side-effect profile was similar to that expected, with the exception of one patient who developed a drug rash with eosinophilia and systemic symptoms. Although CML patients co-morbid for HIV face certain unique challenges when compared to non-infected patients, their long-term outcome can be positive when appropriately managed.


Chronic myeloid leukaemia HIV Treatment adherence 


  1. 1.
    Spano JP, Costagliola D, Katlama C, Mounier R, Oksenhendler E, Khayat D. AIDS-related malignancies: state of the art and therapeutic challenges. J Clin Oncol. 2008;26:4834–42.PubMedCrossRefGoogle Scholar
  2. 2.
    Verneris MR, Tuel L, Seibel NL. Pediatric HIV infection and chronic myelogenous leukemia. Pediatr AIDS HIV Infect. 1995;6:292–4.PubMedGoogle Scholar
  3. 3.
    Schlaberg R, Fisher JG, Flamm MJ, Murty VV, Bhagat G, Alobeid B. Chronic myeloid leukemia and HIV-infection. Leuk Lymphoma. 2008;49:1155–60.PubMedCrossRefGoogle Scholar
  4. 4.
    Mahon FX, Nabera CB, Pellegin JL, Cony-Makhoul P, Leng B, Bernard P, et al. Improving the cytogenetic response to interferon alpha by zidovudine (AZT) in an HIV-positive chronic myelogenous leukemia patient. Leuk Lymphoma. 1997;26:205–7.PubMedGoogle Scholar
  5. 5.
    De la Tribonniere X, Leberre R, Plantier I, Alfandari S, Beuscart S, Jouet JP, et al. Chronic myelogenous leukemia in an HIV-infected patient. Infection. 1998;26:194.PubMedCrossRefGoogle Scholar
  6. 6.
    Tsimberidou AM, Medina J, Cortes J, Rios A, Bonnie G, Faderl S, et al. Chronic myeloid leukemia in a patient with acquired immune deficiency syndrome: complete cytogenetic response with imatinib mesylate: report of a case and review of the literature. Leuk Res. 2004;28:657–60.PubMedCrossRefGoogle Scholar
  7. 7.
    O’Brien SG, Guilhot F, Goldman DM, et al. International Randomized Study of Interferon Versus STI571 (IRIS) 7-year follow-up: sustained survival, low rate of transformation and increased rate of major molecular response in patients with newly diagnosed chronic myeloid leukemia in chronic phase treated with imatinib. Blood. 2008;112:Abstract 186.Google Scholar
  8. 8.
    Sterne JA, Hernán MA, Ledergerber B, Tilling K, Weber R, Sendi P, et al. Long-term effectiveness of potent antiretroviral therapy in preventing AIDS and death: a prospective cohort study. Lancet. 2005;366:378–84.PubMedCrossRefGoogle Scholar
  9. 9.
    Sant M, Allemani C, Tereanu C, De Angelis R, Capocaccia R, Visser O, et al. Incidence of hematologic malignancies in Europe by morphologic subtype: results of the HAEMACARE project. Blood. 2010;116:3724–34.PubMedCrossRefGoogle Scholar
  10. 10.
    Boma PO, Durosinmi MA, Adediran IA, Akinola NO, Salawu L. Clinical and prognostic features of Nigerians with chronic myeloid leukemia. Niger Postgrad Med J. 2006;13:47–52.PubMedGoogle Scholar
  11. 11.
    Mukiibi JM, Nyirenda CM, Paul B, Adewuyi JO, Mzula EL, Malata HN. Chronic myeloid leukemia in central Africans. East Afr Med J. 2003;80:470–5.PubMedGoogle Scholar
  12. 12.
    Liebowitz MR, Derman DP, Jacobson R, Stevens K, Katz J. Chronic myeloid leukaemia in South African blacks. S Afr Med J. 1976;50:2035–7.Google Scholar
  13. 13.
    Rohrbacher M, Berger U, Hochhaus A, Metzgeroth G, Adam K, Lahaye T, et al. Clinical trials underestimate the age of chronic myeloid leukemia (CML) patients. Incidence and median age of Ph/BCR–ABL-positive CML and other chronic myeloproliferative disorders in a representative area in Germany. Leukemia. 2009;23:602–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Othieno-Abinya NA, Nyabola LO, Kiarie GW, Ndege R, Maina JM. Chronic myeloid leukemia at the Kenyatta National Hospital. Nairobi East Afr Med J. 2002;79:593–7.Google Scholar
  15. 15.
    Southern African HIV Clinicians Society. Guidelines: antiretroviral therapy in adults. Accessed 6 Sept 2011.
  16. 16.
    Sokal JE, Cox EB, Baccarani M, Tura S, Gomez GA, Robertson JE, et al. Prognostic discrimination in “good-risk” chronic granulocytic leukemia. Blood. 1984;63:789–99.PubMedGoogle Scholar
  17. 17.
    Hasford J, Pfirrmann M, Hehlmann R, Allan NC, Baccarani M, Kluin-Nelemans JC, et al. A new prognostic score for survival of patients with chronic myeloid leukemia treated with interferon alfa. J Natl Cancer Inst. 1998;90:850–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Hasford J, Baccarani M, Hoffmann V, Guilhot J, Saussele S, Rosti G, et al. Predicting complete cytogenetic response and subsequent progression-free survival in 2060 patients with CML on imatinib treatment: the EUTOS score. Blood. 2011;118:686–92.PubMedCrossRefGoogle Scholar
  19. 19.
    Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353:487–97.PubMedCrossRefGoogle Scholar
  20. 20.
    Paterson DL, Swindells S, Mohr J, Brester M, Vergis EN, Squier C, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med. 2000;133:21–30.PubMedGoogle Scholar
  21. 21.
    Noens L, van Lierde MA, de Bock R, Verhoef G, Zachée P, Berneman Z, et al. Prevalence, determinants, and outcomes of nonadherence to imatinib therapy in patients with chronic myeloid leukemia: the ADAGIO study. Blood. 2009;113:5401–11.PubMedCrossRefGoogle Scholar
  22. 22.
    Marin D, Bazeos A, Mahon FX, Eliasson L, Milojkovic D, Bua M, et al. Adherence is the critical factor for achieving molecular responses in patients with chronic myeloid leukemia who achieve complete cytogenetic responses on imatinib. J Clin Oncol. 2010;28:2381–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Ganesan P, Sagar TG, Dubashi B, Rajendranath R, Kannan K, Cyriac S, et al. Nonadherence to imatinib adversely affects event free survival in chronic phase chronic myeloid leukemia. Am J Hematol. 2011;86:471–4.PubMedCrossRefGoogle Scholar
  24. 24.
    Cramer J. Identifying and improving compliance patterns. In: Cramer JA, Spilker B, editors. Patient compliance in medical practice and clinical trials. New York: Raven Press; 1991. p. 387–92.Google Scholar
  25. 25.
    Sewitch MJ, Abrahamowicz M, Barkun A, Bitton A, Wild GE, Cohen A, et al. Patient nonadherence to medication in inflammatory bowel disease. Am J Gastroenterol. 2003;98:1535–44.PubMedCrossRefGoogle Scholar
  26. 26.
    Baccarani M, Cortes J, Pane F, Niederwieser D, Sagglio G, Apperley J, et al. Chronic myeloid leukemia: an update of concepts and management recommendations of European LeukemiaNet. J Clin Oncol. 2009;27:6041–51.PubMedCrossRefGoogle Scholar
  27. 27.
    Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clin Ther. 2001;23:1296–310.PubMedCrossRefGoogle Scholar
  28. 28.
    Salami AK, Fadeyi A, Ogunmodede JA, Desalu O. Factors influencing adherence to antiretroviral medication in Ilorin, Nigeria. J Int Assoc Physicians AIDS Care. 2010;9:191–5.CrossRefGoogle Scholar
  29. 29.
    Partridge AH, Avorn J, Wang PS, Winer EP. Adherence to therapy with oral antineoplastic agents. J Natl Cancer Inst. 2002;94:652–61.PubMedCrossRefGoogle Scholar
  30. 30.
    Eliasson L, Clifford S, Barber N, Marin D. Exploring chronic myeloid leukemia patients’ reasons for not adhering to the oral anticancer drug imatinib as prescribed. Leuk Res. 2011;35:626–30.PubMedCrossRefGoogle Scholar
  31. 31.
    Murphy RA, Sunpath H, Kuritzkes DR, Venter F, Gandhi RT. Antiretroviral therapy-associated toxicities in the resource-poor world: the challenge of a limited formulary. J Infect Dis. 2007;196(Suppl 3):S449–56.PubMedCrossRefGoogle Scholar
  32. 32.
    Kantarjian HM, Larson RA, Guilhot F, O’Brien SG, Druker BJ. Declining rates of adverse events (AEs), rare occurrence of serious AEs, and no unexpected long-term side effects at 5 years in patients with newly diagnosed chronic myeloid leukemia in chronic phase initially treated with imatinib in the international randomized study of interferon vs STI571 (IRIS). Blood. 2006;108(Suppl):Abstract 2136.Google Scholar
  33. 33.
    Kantarjian H, Shah NP, Hochhaus A, Cortes J, Shah S, Ayala M, et al. Dasatinib versus imatinib in newly diagnosed chronic-phase chronic myeloid leukemia. N Engl J Med. 2010;362:2260–70.PubMedCrossRefGoogle Scholar
  34. 34.
    Cortes JE, Jones D, O’Brien S, Jabbour E, Ravandi F, Koller C, et al. Results of dasatinib therapy in patients with early chronic-phase chronic myeloid leukemia. J Clin Oncol. 2010;28:398–404.PubMedCrossRefGoogle Scholar
  35. 35.
    Marin D, Marktel S, Bua M, Szydlo RM, Franceschino A, Nathan I, et al. Prognostic factors for patients with chronic myeloid leukemia in chronic phase treated with imatinib mesylate after failure of interferon-alpha. Leukemia. 2003;17:1448–53.PubMedCrossRefGoogle Scholar
  36. 36.
    Calenda V, Chermann JC. The effects of HIV on hematopoiesis. Eur J Haematol. 1992;48:181–6.PubMedCrossRefGoogle Scholar
  37. 37.
    Miguez-Burbano MJ, Jackson J Jr, Hadrigan S. Thrombocytopenia in HIV disease: clinical relevance, physiopathology and management. Curr Med Chem Cardiovasc Hematol Agents. 2005;3:365–76.PubMedCrossRefGoogle Scholar
  38. 38.
    Peltzer K. Utilization and practice of traditional/complementary/alternative medicine (TM/CAM) in South Africa. Afr J Tradit Complement Altern Med. 2009;6:175–85.PubMedGoogle Scholar
  39. 39.
    Gleevec® (Imatinib) Prescribing Information. East Hanover (NJ): Novartis Pharmaceutical Company. Accessed 11 June 2010.
  40. 40.
    Bolton AE, Peng B, Hubert M, Krebs-Brown A, Dapdeville R, Keller U, et al. Effect of rifampicin on the pharmacokinetics of imatinib mesylate (Gleevec, STI571) in healthy subjects. Cancer Chemother Pharmacol. 2004;53:102–6.PubMedCrossRefGoogle Scholar
  41. 41.
  42. 42.
    Phillips E, Mallal S. Drug hypersensitivity in HIV. Curr Opin Allergy Clin Immunol. 2007;7:324–30.PubMedCrossRefGoogle Scholar
  43. 43.
    Goldman J, Duval-Modeste AB, Lambert A, Contentin N, Courville P, Musette P, et al. Imatinib-induced DRESS (Article in French). Ann Dermatol Venereol. 2008;135:393–6.PubMedCrossRefGoogle Scholar
  44. 44.
    Cortes JE, Baccarani M, Guilhot F, Druker BJ, Branford S, Kim DW, et al. Phase III, randomized, open-label study of daily imatinib mesylate 400 mg versus 800 mg in patients with newly diagnosed, previously untreated chronic myeloid leukemia in chronic phase using molecular end points: tyrosine kinase inhibitor optimization and selectivity study. J Clin Oncol. 2010;28:424–30.PubMedCrossRefGoogle Scholar
  45. 45.
    Picard S, Titier K, Etienne G, Teilhet E, Ducint D, Bernard MA, et al. Trough imatinib plasma levels are associated with both cytogenetic and molecular responses to standard-dose imatinib in chronic myeloid leukemia. Blood. 2007;109:3496–9.PubMedCrossRefGoogle Scholar
  46. 46.
    Larson RA, Druker BJ, Guilhot F, O’Brien SG, Riviere GJ, Krahnke T, et al. Imatinib pharmacokinetics and its correlation with response and safety in chronic-phase chronic myeloid leukemia: a subanalysis of the IRIS study. Blood. 2008;111:4022–8.PubMedCrossRefGoogle Scholar
  47. 47.
    Santachiara R, Maffei R, Martinelli S, Arcari A, Piacentini F, Trabacchi E, et al. Development of hypogammaglobulinemia in patients treated with imatinib for chronic myeloid leukemia or gastrointestinal stromal tumor. Haematologica. 2008;93:1252–5.PubMedCrossRefGoogle Scholar
  48. 48.
    Cervetti G, Carulli G, Galimberti S, Azzarà A, Canmizzo E, Buda G, et al. Reduction of immunoglobulin levels during imatinib therapy of chronic myeloid leukemia. Leuk Res. 2008;32:191–2.PubMedCrossRefGoogle Scholar
  49. 49.
    Humlová Z, Klamová H, Janatková I, Sandová P, Sterzl I, Sobotková E, et al. Changes of immunological profiles in patients with chronic myeloid leukemia in the course of treatment. Clin Dev Immunol. 2010;2010:137320.PubMedCrossRefGoogle Scholar
  50. 50.
    Weichsel R, Dix C, Wooldridge L, Clement M, Fenton-May A, Sewell AK, et al. Profound inhibition of antigen-specific T-cell effector functions by dasatinib. Clin Cancer Res. 2008;14:2484–91.PubMedCrossRefGoogle Scholar
  51. 51.
    Chen J, Schmitt A, Chen B, Rojewski M, Rübeler V, Fei F, et al. Nilotinib hampers the proliferation and function of CD8+ T lymphocytes through inhibition of T cell receptor signalling. J Cell Mol Med. 2008;12:2107–18.PubMedCrossRefGoogle Scholar

Copyright information

© The Japanese Society of Hematology 2012

Authors and Affiliations

  • Michael J. Webb
    • 1
  • Claire L. Barrett
    • 2
  • Christel Pretorius
    • 2
  • Magdalena F. van Jaarsveld
    • 1
  • Vernon J. Louw
    • 1
  1. 1.Division of Clinical Haematology, Department of Internal Medicine (G73), Faculty of Health SciencesUniversity of the Free StateBloemfonteinSouth Africa
  2. 2.Department of Internal Medicine, Faculty of Health SciencesUniversity of the Free StateBloemfonteinSouth Africa

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