Chronic myeloid leukaemia in South Africa.

Despite the challenges of a resource-limited environment, the outcome of chronic myeloid leukaemia (CML) patients in South Africa is similar to that in developed countries, thanks to access to tyrosine kinase inhibitors through patient assistance programmes and clinical trials. A number of challenges are faced in terms of reimbursement of drugs, simultaneous co-infection with human immunodeficiency virus, access to allogeneic stem cell transplantation and, until recently, a lack of local recommendations appropriate for our setting. It is hoped that the newly published recommendations for the management of CML in South Africa will close many of the gaps in knowledge and practice and thus translate into better patient outcomes. Epidemiological data are limited and there is a need for more collaborative studies locally to elucidate issues such as incidence, prevalence and response to treatment. The challenges experienced in the management of CML and other cancers in the developing world are often economical and political in nature and require a comprehensive approach by clinicians, pathologists, health economists, medical insurers and policy makers if we are to find sustainable solutions.