Clinical Case Discussion Forum
To share and enhance best practice management of CML, experts and interested clinicians can discuss difficult or interesting CML cases here. Physicians submit a brief history of the patient and the case for discussion using this forum.
CML in younger patients in low socio-economic areas
Topic
CML in younger patients in low socio-economic areas
was created by
nasirwazir
nasirwazir
unknown
02:02 25 February 2022
Dear all, excuse me for this is not a case I am going to write about but cases.
I hope all the senior members are here to enlighten me. I recently wrote my dissertation and was shocked to see the CML prevalence in the youngers in our population.
I studied further and noted that most of the countries have reported this including Pakistan and India.
What could be the possible scientific explanation for CML prevalence at a younger age in low socio-economic courtiers when compared with developed countries?
Thanks for your query. It’s important always to draw conclusions from high quality population based data with mandatory case reporting such as SEER. unfortunately, there are no similar databases in India or Pakistan. Also, for a cancer like CML we need to consider age adjusted incidence rate (AAIR). This will help us adjust for the high proportion of young people, especially in lower sociology-economic situations in resource poor compared with resource rich geospaces. Years ago when I was interested in CLL in children I was surprised to find most reports were from India. Then I realized there are lots of children there, in fact at that time 1/2 of all children were in India or China. Hope this helps. Stay safe. KR.
Thanks for your very relevant question.
All the published studies from LMIC (including several large series from India) have shown that the average age at diagnosis of CML patients is at least one decade earlier as compared to the west.
As pointed out by Dr. Gale and from one population-based cancer register from Mumbai, the age-adjusted incidence rates may not too difference between regions.
Without doubt the AAIR is more scientific than crude incidence rates.
Still the fact remains, that there are a very large number of young patients in LMICs and dealing with them, especially fertility & pregnancy issues, issues of long-tern TKI toxicities and issues related to TFR, become significant & need special attention.
Hope this helps.
Best wishes.
Thank you, Prof Gale. Yes, It does help and encourages me. Obviously, the AAIR would be a better option but it would be more like epidemiological or statistical inferences. What I was looking for is the underlying scientific cause which still remains the same as Dr. Malhotra just wrote down. I could not find any relevant studies that have reported the scientific cause and not even a well-defined description-based hypothesis. I was looking forward if you could kindly help me out.
I might plan a comparative exome/ genome analysis. Thanks again.
Sincerely
Nasir
Thank you, Prof. Malhotra. I have followed your articles and your answer was helpful. I would request you to guide us on my reply to Prof. Gale if and when posted by the moderator.
Thank you
Nasir