Nelson Robert P, Cornetta Kenneth, Ward Kelly E, Ramanuja Srinivasan, Fausel Chris, Cripe Larry D
Hematological Malignancy Program/Immunology, Division of Hematology/Oncology, Indiana University Hospital, Clarion Health Partners, USA.
Ann Allergy Asthma Immunol. 2006 Aug;97(2):216-22. doi: 10.1016/S1081-1206(10)60016-6.
Imatinib mesylate is a tyrosine kinase inhibitor used for the treatment of chronic myeloid leukemia and hypereosinophilic syndrome. Imatinib is associated with a variety of adverse cutaneous reactions, including urticaria, maculopapular exanthem, generalized exanthematous pustulosis, exfoliative dermatitis, and Stevens-Johnson syndrome.
To evaluate the safety and efficacy of oral desensitization by administering incremental dosages of imatinib mesylate to patients with leukemia who have had rashes associated with prior exposure.
Ten patients with leukemia and imatinib-associated recurrent rash underwent a 4-hour outpatient oral desensitization procedure. Beginning with 10 ng, we administered oral imatinib elixir in increasing dosages every 15 minutes. Patient outcomes were monitored by a return clinic visit and by telephone follow-up for a median of approximately 3 years.
No episodes of anaphylaxis or serious adverse effects occurred during or immediately after desensitization. Four patients (all with urticaria) had no recurrence of rash after desensitization, and 4 had recurrent rash that resolved after temporary glucocorticosteroid and antihistamine administration. Two patients developed a recurrent rash 5 hours and several days after the procedure and were unable to resume therapy.
This oral desensitization protocol appears to help some leukemic patients with recurrent rash tolerate imatinib mesylate, thus permitting continuation of this life-prolonging therapy. These findings suggest that some adverse cutaneous reactions to imatinib may be due to a hypersensitivity mechanism rather than a pharmacologic effect.
甲磺酸伊马替尼是一种酪氨酸激酶抑制剂，用于治疗慢性粒细胞白血病和高嗜酸性粒细胞综合征。伊马替尼与多种皮肤不良反应相关，包括荨麻疹、斑丘疹、全身性脓疱性皮疹、剥脱性皮炎和史蒂文斯-约翰逊综合征。
通过对先前接触过伊马替尼并出现皮疹的白血病患者递增剂量口服甲磺酸伊马替尼，评估口服脱敏的安全性和有效性。
10例患有白血病且与伊马替尼相关的复发性皮疹患者接受了为期4小时的门诊口服脱敏程序。从10纳克开始，我们每15分钟递增剂量口服伊马替尼酏剂。通过复诊和电话随访对患者结果进行监测，中位随访时间约为3年。
脱敏期间或脱敏后即刻未发生过敏反应或严重不良反应。4例患者（均为荨麻疹）脱敏后皮疹未复发，4例患者复发性皮疹在临时给予糖皮质激素和抗组胺药后消退。2例患者在程序后5小时和数天出现复发性皮疹，无法恢复治疗。
这种口服脱敏方案似乎有助于一些患有复发性皮疹的白血病患者耐受甲磺酸伊马替尼，从而使这种延长生命的治疗得以继续。这些发现表明，伊马替尼的一些皮肤不良反应可能是由于超敏反应机制而非药理作用。
