Modernising diagnosis and treatment of Chronic Myeloid Leukaemia for improved patient outcomes in a resource-limited setting: Experiences from Ghana’s premier teaching hospital

Introduction: Until 2013, diagnosis of Chronic Myeloid Leukaemia (CML) at Korle-Bu Teaching Hospital (KBTH) in Ghana was based on white blood cell morphology ascertained from peripheral blood and bone marrow aspirate. Access to cytogenetic studies or molecular testing locally was limited, making testing prohibitively expensive and out of reach of majority of patients. Additionally, the only treatment options available were the antimetabolites, hydroxyurea and busulfan, which produced suboptimal disease response and haematological remission. These treatment options are considered outmoded currently, especially after the introduction of tyrosine kinase inhibitors, which have improved patient survival considerably. This paper details the processes and outcomes of a transformative reform of CML management in Ghana’s foremost teaching hospital. Methods: We collected data on the processes implemented for the commencement of the Glivec International Patient Assistance Programme (GIPAP) for CML management in KBTH. Data on program partnership, infrastructure development, health worker training, supply of medications and other logistics, as well as implementation and treatment outcomes, were collected. Results: From 2007, the Haematology Department of the KBTH progressively commenced a series of initiatives to advance the diagnosis and treatment of CML. This included leveraging patient-assisted programmes to build strategic and functional partnerships, sourcing of funding for infrastructure improvement and formation of a patient support group. The GIPAP has given patients at the KBTH CML Centre access to tyrosine kinase inhibitors since 2007 and also the ability to do molecular testing in-house since 2013. Uptake of molecular testing has increased, just as monitoring of molecular status during treatment, with almost all patients on treatment achieving haematological remission within a relatively short time of two months. Conclusion: Availability of in-house molecular testing and treatment with tyrosine kinase inhibitors, apart from being relatively cheaper than traditional management modalities have resulted in improved uptake of CML management and patient outcomes.