Improving Treatment Outcomes in Chronic Myeloid Leukaemia Patients Using Imatinib and Artesunate Combination Therapy

Chronic myeloid leukaemia (CML) is a blood cancer with an annual worldwide incidence of 1/100,000 population. Imatinib is used for the treatment of CML and has significantly improved the management of the disease. However, the incidence of treatment failure due to imatinib resistance has become a considerable burden (Sherbenou et al., 2007). Artesunate, an antimalarial drug, is reported to have anti-neoplastic effect either singly or in synergy with already established anti-neoplastic agents (Krishna et al., 2015). The aim of the study is to evaluate the clinical effectiveness of an Imatinib-artesunate combination compared to imatinib alone and its possibility as an alternative option in the management of sub-optimal response in CML patients especially in low- and middle- income country like Nigeria where second line tyrosine kinase inhibitor may be out of reach. The specific objectives are to: 1. Assess the safety of artesunate use beyond its traditional antimalarial dosing period in CML patients. 2. Compare treatment outcomes between patients on imatinib alone and patients on imatinib plus artesunate at 3, 6 and 12-months of follow-up. 3. Determine the effect of imatinib and artesunate combination on the achievement of major molecular remission in CML patients with sub-optimal response to imatinib. 4. Determine the effect of artesunate on imatinib pharmacokinetics following co-administration of the two drugs. The main questions it aims to answer is: * Does the use of artesunate in combination with imatinib in newly diagnosed CML patient give a better therapeutic outcome than using imatinib alone? * Does combining artesunate with imatinib in CML patients with sub-optimal response to imatinib improve patients' response to imatinib? * Does combining artesunate with imatinib in CML patients affect the pharmacokinetic parameter of imatinib? * Is it safe to take artesunate at 4mg/day (not exceeding 200mg/day) for a 14day cycle in CML patients as demonstrated in other forms of cancer? Participants will be assigned to one of the groups of the study and continue imatinib medication irrespective of the group assigned and come to clinic once a month for follow-up. Clinic visits will be immediately after a cycle of artesunate for groups B and C.

Sex

All

Minimum age

18 Years

Maximum age

85 Years

Inclusion Criteria:

* Newly diagnosed chronic phase CML patients
* Patients with sub-optimal response to imatinib therapy
* Ages between 18 years and 85 years with written informed consent

Exclusion Criteria:

* Patients with documented hypersensitivity to artesunate
* Patients with cardiovascular disease, pregnancy and inability to give consent will be excluded.
* Patients currently on any medication(s) that may interact with imatinib or affect its pharmacokinetics parameters (like rifampicin and ketoconazole) will be excluded.

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