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Although therapeutic drug monitoring (TDM) is an important tool in guiding drug dosing for other areas of medicine including infectious diseases, cardiology, psychiatry and transplant medicine, it has not gained wide acceptance in oncology. For imatinib and other tyrosine kinase inhibitors, a flat dosing approach is utilised for management of oral chemotherapy. There are many published studies examining the correlation of blood concentrations with clinical effects of imatinib. The International Association of Therapeutic Drug Monitoring and Clinical Toxicology (IATDMCT) determined that there was a need to examine the published literature regarding utility of TDM in imatinib therapy and to develop consensus guidelines for TDM based on the available data. This article summarises the scientific evidence regarding TDM of imatinib, as well as the consensus guidelines developed by the IATDMCT.

Introduction:Chronic myeloid leukaemia (CML) is a myeloproliferative neoplasm characterised by the overproduction of haematopoietic cells in the granulocytic series, involving translocation of chromosomes 9 and 22. The first tyrosine kinase inhibitor, imatinib, used in the treatment of CML, represents one of the most successful targeted therapies marking a new era in the treatment of CML. Many scoring systems such as the Hasford and Sokal systems have been developed to stratify CML patients into risk categories, and to predict patient outcome. We aimed to evaluate the relationship between blood lymphocyte count (BLC) at diagnosis and molecular response to imatinib therapy as a prognostic factor.Methods:A total of 108 chronic phase CML patients diagnosed between January 2010 and January 2020 were evaluated. Patient characteristics, laboratory results, BLC and response to treatment were recorded.Results:The median BLC was 4,665/mm3 and patients were divided into two groups according to the median BLC as ≤4,665/mm³ and >4,665/mm³. The responses at 3, 6, 12 month and the final status of patients, namely achievement of major molecular response or not, did not differ between the two groups of patients.Conclusion:The introduction of new therapeutic options in CML necessitates improvement in existing risk scoring systems. No direct relationship was found between the initial BLC and imatinib response in CML. However this is the first study exploring the role of BLC at diagnosis in CML patients receiving imatinib, and further studies that look into lymphocyte subgroups as well as bone marrow lymphocyte count at diagnosis might allow a more precise evaluation about the contribution of lymphocyte count to risk assessment in CML patients.

BACKGROUND: Acute myeloid leukemia (AML) harboring 11q23 translocations is classified as therapy-related AML in patients who have undergone prior treatment with cytotoxic agents. There have been only a few reports of AML that subsequently developed during imatinib mesylate (IM) treatment for gastrointestinal stromal tumors (GISTs). CASE SUMMARY: A 63-year-old woman was diagnosed with a hepatic GIST recurrence in April 2012; she was administered IM 400 mg/d. In November 2015, she developed dyspnea with pancytopenia while IM treatment was continued for 42 mo. A chromosome study using a bone marrow sample showed a 46, XX karyotype with t(11;19)(q23;p13.1) in 22 of 26 analyzed metaphase cells. Fluorescence in situ hybridization using the locus-specific indicator (11q23) gene break-apart probe showed positive rearrangement in 82% of interphase cells. Reverse-transcription polymerase chain reactions subsequently confirmed the KMT2A/ELL transcript. She achieved complete response with incomplete neutrophil recovery with two decitabine treatment cycles. After the third cycle of decitabine, the disease relapsed, and she refused further treatment. She died of hemorrhagic stroke 5 mo after diagnosis. To the best of our knowledge, this is the first report of AML with KMT2A gene rearrangements in a patient with a GIST receiving IM treatment. CONCLUSION: Physicians should consider the potential risks of developing hematologic malignancies, including therapy-related AML, in patients with GISTs receiving IM treatment.

Nephrogenic systemic fibrosis (NSF) is a sclerotic disorder presenting with painful indurated plaques and skin thickening involving the trunk and extremities, which can lead to tethering and joint contractures. NSF most commonly affects patients with renal insufficiency who have been exposed to gadolinium. We present a case of NSF involving the bilateral hands, knees, and lower extremities developing over 10 years after gadolinium exposure. Initial improvement was noted in the lower extremities after initiation of imatinib mesylate therapy, but recalcitrant, thickened hand plaques caused persistent pain and functional limitation. Adjunct intralesional corticosteroid injections produced durable softening of the recalcitrant lesions with considerable functional improvement in hand mobility. Based on our experience, intralesional corticosteroid injections appear to be an effective adjunct treatment in patients with incomplete response to anti-fibrotic therapies.

Extramedullary blast crisis (BC) presenting as the central nervous system (CNS) involvement in chronic myeloid leukemia (CML) is rare and usually accompanies systemic involvement. Imatinib has shown efficacy in treating patients with CML in accelerated or blastic phases. However, CNS penetration of Imatinib is poor due to the P-glycoprotein mediated efflux mechanisms. Therefore, patients on long-term Imatinib therapy with hematological and cytogenetic remission may rarely present with CNS BC. Isolated CNS BC is uncommon and the literature is limited to only a few case reports. Here, we present two cases of isolated CNS BC in patients with BCR ABL positive CML on treatment.

Background: First generation tyrosine kinase inhibitor, imatinib revolutionized the treatment of chronic myeloid leukaemia, and is now the front line therapy. Imatinib provides substantial cytogenetic and molecular remission, with minimal normal hematopoiesis suppression or side effects and is now first line therapy. Objective: The aim of this prospective study was to determine the efficacy of imatinib therapy in the management of chronic myeloid leukemia in Bangladesh. Methods: This prospective study was done from June 2012 to May 2018. In this period we treated eight chronic myeloid leukaemia patients with imatinib, in Khulna division, Bangladesh. Results: Majority of the patients (50%) were in the age group of 21-30 years. Three patients died as because those patients were too poor to continue drugs. Another 5 patients were in good health and continuing follow up monthly. Among five patients, one patient have two healthy son. Conclusion: Imatinib therapy is an effective treatment regimen in the management of chronic myeloid leukaemia. The best result can be obtained if CML is dignosed earlier. Bang Med J (Khulna) 2018; 51 : 40-43

Rectal gastrointestinal stromal tumor (GIST) is a rare entity. Thus, its clinical features have not been well documented, and optimal treatment strategies have not been established. Surgery for rectal GISTs may be difficult because they are often large in size. In addition, rectal GISTs were found to be associated with high rates of local recurrence, regardless of the surgical procedure, before imatinib was introduced in the early 2000s. Since the introduction of imatinib therapy, accumulating evidence suggests that neoadjuvant imatinib therapy may improve the outcomes of rectal GIST treatment. Neoadjuvant imatinib therapy for rectal GISTs offers a number of potential benefits, including tumor downsizing, reduction in mitotic activity, reduced morbidity, and a reduced risk of recurrence. Less radical procedures may allow for the preservation of the anal sphincter and avoidance of a permanent colostomy. This review summarizes the current status and future perspectives of neoadjuvant imatinib therapy for the treatment of rectal GISTs.

Imatinib mesylate is a tyrosine kinase inhibitor with high efficacy in the treatment of chronic myeloid leukemia (CML). Although fluid retention is a common adverse effect of imatinib, it rarely necessitates discontinuation of therapy. Isolated ascites has not been reported as a complication of imatinib therapy in patients with CML. Here, we report the case of a 72-year-old male with CML on imatinib (600 mg daily), who developed ascites two weeks after a laparoscopic hernia repair with intraperitoneal placement of a nylon mesh. The ascites was resistant to diuretic therapy and required repeated large-volume paracentesis. Discontinuation of imatinib resulted in arrest of ascites production, but reintroduction of the drug at the same dose two weeks later was rapidly followed by recurrence of ascites requiring further therapeutic paracenteses. It was postulated that peritoneal inflammation had resulted in increased capillary permeability, which was further augmented by imatinib via inhibition of platelet-derived growth factor receptor (PDGFR), a tyrosine kinase known to play a significant physiological role in the regulation of interstitial fluid pressure and capillary permeability. The possibility of developing ascites after abdominal surgery should be considered in patients receiving imatinib or related PDGFR inhibitors. In such cases, perioperative interruption of tyrosine kinase therapy might be indicated.

Imatinib is used as first-line treatment for chronic myeloid leukemia (CML) even in patients with impaired renal function. We successfully used therapeutic drug monitoring to determine the dose for re-administration of imatinib in a CML patient who initiated dialysis for acute renal dysfunction associated with the initial imatinib therapy.

Successful treatment of chronic myelogenous leukemia (CML) with tyrosine kinase inhibitors (TKI) is nowadays likely to result in near-normal life expectancy. Nowadays, the treatment-free remission (TFR) is becoming more and more often a therapeutic goal for both hematologist and his patient. TKI discontinuation and maintenance of TFR is feasible in circa 40–50% of CML patients who achieved stable deep molecular response (DMR). Here, we present a patient with CML, who was switched to nilotinib due to imatinib therapy failure. After a few years of sustaining DMR nilotinib was discontinued. One year since this decision, the patient has remained in the TFR.

Describe and characterize the peculiarities of the chronic myeloid leukemia (CML) course and responseto treatment in patients irradiated as a result of the Chornobyl nuclear power plant (ChNPP) accident based on theassessment of clinical-laboratory and clinical parameters.The CML patients (n = 33) exposed to ionizing radiation as a result of the ChNPP accidentwere enrolled. The comparison group consisted of CML patients (n = 725) with no history of radiation exposure. Allpatients were in the chronic phase of the disease. Clinical, hematological and molecular genetic research methodswere applied.Patients exposed to ionizing radiation as a result of the ChNPP accident had no differences in CML manifestation, as well as in classical genetic markers at the onset of the disease compared with patients with no historyof radiation exposure. Reduction of tumor clone on imatinib therapy was significantly less effective in the patientsexposed to ionizing radiation than in cases of no history of radiation exposure. Cases of primary resistance were statistically significantly prevalent in the ChNPP accident consequences clean-up workers while in the residents ofradiologically contaminated areas a statistically significant increase in probability of loss of complete cytogeneticresponse (development of secondary resistance) to imatinib therapy was found. An association was found betweenthe radiation exposure and probability of loss of complete cytogenetic response to imatinib therapy in this group ofpatients.The radiation exposure in the history even many years before the onset of CML is an unfavorable exogenous factor responsible for the development of resistance to imatinib therapy.Meta: nadaty kharakterystyku osoblyvostiam perebigu khronichnoï miieloïdnoï leĭkemiï (KhML) ta vidpovidi na likuvannia sered oprominenykh vnaslidok avariï na Chornobyl's'kiĭ atomniĭ elektrostantsiï (ChAES) patsiientiv na osnovi otsinky kliniko-laboratornykh ta klinichnykh parametriv.Materialy i metody. Obstezheno 33 osoby iz KhML, iaki zaznaly diï ionizuiuchogo vyprominiuvannia vnaslidok avariïna ChAES. Grupu porivniannia sklaly 725 patsiientiv iz KhML bez radiatsiĭnogo anamnezu. Usi patsiienty znakhodylysia vkhronichniĭ fazi zakhvoriuvannia. Vykorystovuvaly kliniko-gematologichni ta molekuliarno-genetychni metody doslidzhennia.Rezul'taty. Patsiienty, iaki zaznaly vplyvu radiatsiĭnogo vyprominiuvannia, ne vidriznialys' osoblyvostiamymanifestatsiï KhML, porivniano z patsiientamy bez radiatsiĭnogo anamnezu, prote dlia nykh vyznachalasia nyz'ka efektyvnist' do terapiï imatynibom. U grupi uchasnykiv likvidatsiï naslidkiv avariï na ChAES statystychno znachushche perevazhaly vypadky rozvytku pervynnoï rezystentnosti, porivniano z grupoiu zhyteliv radiatsiĭno zabrudnenykh terytoriĭ ta grupoiu porivniannia. Vyiavleno statystychno znachushche pidvyshchennia chastoty vtraty dosiagnutoï povnoï tsytogenetychnoï vidpovidi na terapiiu imatynibom u patsiientiv, iaki buly evakuĭovani abo prozhyvaly na radiatsiĭno kontaminovanykh terytoriiakh, porivniano z patsiientamy bez radiatsiĭnogo anamnezu. Vyznacheno asotsiatyvnyĭ zv’iazokmizh vplyvom radiatsiĭnogo faktoru ta virogidnistiu vtraty dosiagnutoï povnoï tsytogenetychnoï vidpovidi na terapiiu imatynibom v tsiĭ grupi patsiientiv.Vysnovky. Naiavnist' radiatsiĭnogo oprominennia v anamnezi navit' za bagato rokiv do debiutu KhML, ie nespryiatlyvym seredovyshchnym faktorom, iakyĭ obumovliuie rozvytok rezystentnosti do terapiï imatynibom.

Duodenal gastrointestinal stromal tumors (dGISTs) are rare, and a lack of consensus exists regarding their therapeutic management particularly for recurrent disease. We present even low-risk dGIST may metastasize and require long-term observation, and a long-term prognosis may be achieved by combining resection and imatinib therapy for liver metastases recurrence.

International audience; No abstract available

Tyrosine kinase inhibitors (TKI) have dramatically improved the prognosis of CML patients with life expectancy close to individuals without CML [1], and therefore the longterm safety of TKIs has become especially important due to the potential for lifelong treatment. Nilotinib (NILO) tends to have a negative effect on lipid [2] and glucose [3] metabolism, while imatinib (IMA) seems to improve [4] these abnormalities. Although the data appear convincing, the real impact of these changes on cardiovascular (CV) risk and the development of CV complications during TKI therapy have not yet been confirmed.

Total pelvic exenteration (TPE) may be the only curative procedure for locally advanced rectal gastrointestinal stromal tumor (GIST) that is contiguous with the adjacent organs and pelvic wall. There is no previous report of laparoscopic TPE for advanced rectal GIST. Here, we describe our experience of performing laparoscopic TPE on a locally advanced rectal GIST after neoadjuvant imatinib chemotherapy. A 62-year-old Japanese man was diagnosed with locally advanced rectal GIST that was contiguous with the seminal vesicles, prostate, and left pelvic sidewall. He received imatinib mesylate for 5 months, after which the mass had shrunk but was still contiguous with adjacent organs. We therefore needed to perform TPE, and we accomplished the operation laparoscopically. The total operative time was 540 minutes and estimated blood loss was 280 mL. There were no intraoperative complications and not required conversion to open surgery. The patient had his first stool on the first postoperative day and discharged on the 21st postoperative day with no major complication. Pathologic examination of the resected specimen revealed negative margins. The patient had further adjuvant imatinib chemotherapy and had no recurrence for 20 months postoperatively. Laparoscopic TPE appears to be minimally invasive surgery and safe in the present case of rectal GIST. This is the first report of a case in the world that underwent laparoscopic TPE for advanced rectal GIST.

Purpose The introduction of tyrosine kinase inhibitors has transformed the care of patients with chronic myeloid leukemia, with survival approaching that of healthy individuals. Current-day challenges in chronic myeloid leukemia care include adherence to tyrosine kinase inhibitor therapy. We studied adherence from resource-constrained settings and tried to analyze the factors responsible for nonadherence in these individuals. We also correlated adherence to current molecular status. Patients and Methods This was a single-center, cross-sectional, observational study from north India. It consisted of a questionnaire-based survey in which a one-to-one interview technique was used by trained nursing staff administering the Modified Morisky Adherence Scale (MMAS-9) questionnaire. Adherence was also measured on the basis of physician’s assessment. JMP 13.0.0 was used for statistical analysis. Results A total of 333 patients with a median age of 42 years were included in the study. The median BCR-ABL/ABL ratio (IS) was 0.175 (0.0 to 98.0). The mean MMAS-9 score was 11 ± 2. Adherence was seen in 54.95% on the basis of MMAS-9, whereas physician’s assessment reported adherence in 90.39% of patients. Using the χ2 test, no relationship was found between the two assessment techniques. There was a significant relationship between major molecular response status and adherence by physician’s assessment and MMAS-9 ( P < .001). Bivariate analysis by logistic fit showed a good relation between the MMAS-9 score and the BCR-ABL/ABL ratio (IS), χ2 (1,220) = 135.45 ( P < .001). On multivariate analysis, enrolment in the Novartis Oncology Access program (a patient assistance program) was significantly associated with adherence ( P = .012). Conclusion This study highlights the lack of adherence in real-world settings and the various factors responsible. Such studies are important from a public health services perspective in various settings around the world because they may lead to corrective action being taken at the institutional level.

The hallmark of diagnosing classical chronic myelogenous leukemia (CML) is the identification of Philadelphia (Ph) chromosome (Chr). However, some CML cases show additional structural/numerical chromosomal abnormalities involving either Ph Chr or more frequently other Chrs. Genetic alterations sparing Ph Chr are commonly called “additional chromosomal abnormalities (ACAs)” which have been extensively analyzed in recent large studies. In contrast, the presence of additional genetic abnormalities in Ph Chr has been anecdotally reported with an ambiguity of their impact on treatment response. In our case, we report a newly diagnosed CML patient with the rarest additional chromosomal aberration affecting Ph Chr which has revealed an optimal response over a period of 2 years of follow-up. This report underlines the importance of re-examining CML cases for any ACAs, especially those occurring in Ph Chr, which might be overlooked easily. Moreover, their possible role in disease prognostication should be sought, as well.

BACKGROUND Imatinib is generally well tolerated in the treatment of advanced gastrointestinal stromal tumors (GIST). Gastrointestinal vascular ectasia (GIVE) and gastric antral vascular ectasia (GAVE), while rare, are significant under-reported complications of imatinib therapy. CASE REPORT We present one patient with GIVE complicating imatinib therapy with a literature review of this rare side-effect. RESULTS A 68-year-old woman was diagnosed with advanced GIST, wild-type CKIT. After 3 months of treatment with imatinib, she had partial response. However, she was diagnosed with GAVE and, later, also with GIVE. During her 3-year imatinib treatment, she suffered from severe anemia and required blood transfusions. Conservative treatments were not helpful and the ectatic lesions resolved only with cessation of imatinib. CONCLUSION This confirms a causal relationship between GIVE and imatinib. GIVE and GAVE should be considered possible causes of anemia and upper gastrointestinal bleeding in patients receiving imatinib therapy.

Background The mathematical design of optimal therapies to fight cancer is an important research field in today’s Biomathematics and Biomedicine given its relevance to formulate patient-specific treatments. Until now, however, cancer optimal therapies have considered that malignancy exclusively depends on the drug concentration and the number of cancer cells, ignoring that the faster the cancer grows the worse the cancer is, and that early drug doses are more prejudicial. Here, we analyze how optimal therapies are affected when the time evolution of treated cancer is envisaged as an additional element determining malignancy, analyzing in detail the implications for imatinib-treated Chronic Myeloid Leukemia. Methods Taking as reference a mathematical model describing Chronic Myeloid Leukemia dynamics, we design an optimal therapy problem by modifying the usual malignancy objective function, unaware of any temporal dimension of cancer malignance. In particular, we introduce a time valuation factor capturing the increase of malignancy associated to the quick development of the disease and the persistent negative effects of initial drug doses. After assigning values to the parameters involved, we solve and simulate the model with and without the new time valuation factor, comparing the results for the drug doses and the evolution of the disease. Results Our computational simulations unequivocally show that the consideration of a time valuation factor capturing the higher malignancy associated with early growth of cancer and drug administration allows more efficient therapies to be designed. More specifically, when this time valuation factor is incorporated into the objective function, the optimal drug doses are lower, and do not involve medically relevant increases in the number of cancer cells or in the disease duration. Conclusions In the light of our simulations and as biomedical evidence strongly suggests, the existence of a time valuation factor affecting malignancy in treated cancer cannot be ignored when designing cancer optimal therapies. Indeed, the consideration of a time valuation factor modulating malignancy results in significant gains of efficiency in the optimal therapy with relevant implications from the biomedical perspective, specially when designing patient-specific treatments., This work was supported by projects MTM2014-56022-C2-2-P and MTM2017-85476-C2-1-P of the Spanish Office of Innovation and Competitiveness and European FEDER Funds, and by projects of the Castile and León Autonomous Government: VA041P17 (with European FEDER Funds), VA138G18 and VA148G18.

Background: Gastrointestinal stromal tumour (GIST) is the commonest mesenchymal malignancy of the gastrointestinal tract. Patient demographics and outcomes following imatinib therapy in South Africa are unknown. Aim: To establish the patient demographics of GIST and the clinical outcomes following imatinib therapy. Setting: Inkosi Albert Luthuli Central Hospital (IALCH), Durban, South Africa. Methods: A quantitative, retrospective, descriptive chart review study was conducted. The study population included patients with a histologic diagnosis of GIST who presented between January 2005 and December 2015 to the facility. Only patients who received imatinib were included in the clinical outcome analysis. Results: Sixty-nine patients were seen during the study period. The mean (SD) age at diagnosis was 57.3 (13.5) years. The male gender (53.6%) was predominant, the black ethnic group (53.6%) was the commonest and the stomach (69.6%) was the most common disease site. Localised disease (53.6%) was the commonest disease category, while high risk (29.7%) and intermediate risk (29.7%) were the majority risk categories. Thirty-six (52.2%) patients received imatinib with a median (IQR) follow-up time of 20.5 (38) months. Eighty-one per cent of patients with localised disease remained in remission after adjuvant imatinib, and 18.2% developed metastatic recurrence. Among patients with locally advanced disease, 81.8% attained partial response on neoadjuvant imatinib, while 9.1% had stable disease. Most (75%) patients with metastatic disease attained partial response as the best response to imatinib. The most common adverse effects were anaemia and fluid overload. Conclusion: At IALCH, GIST is more common in the male gender, black ethnic group and in the stomach. The majority of localised and locally advanced GIST patients have favourable outcomes on imatinib. However, most metastatic GIST patients eventually develop resistance to imatinib necessitating further treatment options.

İmatinibin in vivo ortamda T lenfositfonksiyonları üzerine olan etkileri akım sitometrik olarakdeğerlendirilmiştir. Çalışmaya toplam 29 KML hastası ve 9 sağlıklı bireydahil edilmiştir. KML hastaları kendi aralarında sırasıyla, yeni tanı almış vetedavi görmeyen, 1 yıldır imatinib alan ve 1 yıldan uzun süredir imatinib alanhastalar olarak 3 gruba ayrılmıştır. CD4+ hücreler ve bu hücrelerdeki IL-4ve IFNg ifadeleri, CD3+ T lenfositlerin % kaçının aktive edilmiş olduğu(CD3+CD69+), CD8+ hücreler ve bu hücrelerde HLA-ABC ve HLA-DR ifade edenhücrelerin oranı ve HLA-ABC ve HLA-DR ifadelerinin şiddeti değerlendirilmiştir. Gruplar arasında ortalama CD4 + hücresayısı açısından anlamlı fark yoktu. Bununla birlikte, kontrol grubunda dahayüksek CD4 + hücrelerine doğru bir eğilim vardı. IL-4 ve IFN gama, gruplararasında istatistiksel olarak anlamlı bulunmadı. Kontrol grubu daha düşük IL-4ve IFN gama ifade değerlerine sahipti. IL-4 ve IFN gama ifade etmeyen ortalamaCD4 + hücre sayısı kontrol grubunda diğer gruplara göre istatistiksel olarakdaha yüksekti. Kontrol grubunda ise % aktivasyon diğer gruplara göre azdı. Tümhasta gruplarında CD8 + hücre oranı istatistiksel olarak daha düşük bulundu (p= 0,001). HLA-ABC ve HLA-DR'nin CD8 + hücrelerinde ekspresyonu gruplar arasındabenzerdi. İmatinibin sitokin sentezi üzerine herhangi bir etkisigözlenmemiştir. İmatinib tedavisi altındaki hastalarda T lenfositfonksiyonlarının etkilendiğine dair klinik belirgin gözlemler olmamaklabirlikte, subklinik etki varlığı araştırma konusudur. Yapılan in vitro çalışmaların in-vivokorele olup olmadığının aydınlatılabilmesi için daha ileri çalışmalaragereksinim vardır., To analyzeT cell functions by flow cytometry and to evaluate the possible functionalchanges that might occur under imatinib therapy in CML patients. A total of 29patients and 9 healthy control subjects were enrolled. Newly diagnosed patientshaving no treatment (group 1), patients receiving imatinib for 1 year (group 2)and patients receiving imatinib more than 1 year (group 3), healthy controlsubjects (group 4). IL-4 and IFN gamma expression on CD4+ cells; how muchpercentage of CD3+ T cells were activated (CD3+CD69+); CD8+ T cells and theratio and grade of expression of HLA-ABC and HLA-DR on those cells wereevaluated, respectively. There wasno significant difference in terms of mean number of CD4+ cells between thegroups. However, there was a tendency towards higher CD4+ cells in controlgroup. IL-4 and IFN gamma were found not to be statistically significantbetween the groups. Control group has lower IL-4 and IFN gamma expressionvalues. Mean number of CD4+ cells, which did not express IL-4 and IFN gamma,were statistically higher in control group when compared to other groups. Incontrol group, % activation was decreased when compared to that of othergroups. CD8+ cell ratio was found to be statistically lower in all patientgroups (p=0.001). The expression of HLA-ABC and HLA-DR on CD8+ cells weresimilar between the groups. We could not show any inhibitory effect of imatinibon T cell functions in concordance with clinical experience and safety profile.

A 70-year-old gentleman underwent prostatectomy for bladder outlet obstruction due to enlarged prostate and was found to have primary extragastrointestinal stromal tumour (EGIST). He has been started on imatinib therapy and is presently on follow-up. Prostatic EGIST should be one of the differential diagnoses in patients with enlarged prostate with normal prostate-specific antigen levels.Key words: Prostate, gastrointestinal stromal tumour, PSA