Miyazaki Koji, Kon Shinya, Watanabe Takuro, Togano Tomiteru, Ohsaka Manabu, Suzuki Yuhko, Danbara Mikio, Horie Ryouichi, Kanda Yoshinobu, Maruta Atsuo, Higashihara Masaaki
Department of Hematology, Kitasato University School of Medicine.
Rinsho Ketsueki. 2007 Apr;48(4):297-304.
We report herein on two rare cases of newly diagnosed chronic myeloid leukemia, which developed early blastic transformation within a year of imatinib treatment. Case 1 is a 22-year-old Japanese female, who underwent gradual blastic transformation with the increase of a resistant clone, which cytogenetically evolved right after she reached complete hematologic remission. Case 2 is a 24-year-old Japanese male, who underwent sudden transformation after 8 months treatment with imatinib mesylate following complete cytogenetic response. Although a sudden blastic transformation is extremely rare, the occurrence of such events even among the low-risk, good responding patients highlights the need for continued, rigorous monitoring by sensitive analysis, such as quantitative PCR. In order to accomplish the early eradication of minimal residual disease, the therapeutic strategy for chronic myeloid leukemia has to be defined in the era of imatinib, considering the application of allogeneic stem cell transplantation, which is currently the only curative treatment.
我们在此报告两例新诊断的慢性髓性白血病罕见病例，这两例在伊马替尼治疗一年内就发生了早期原始细胞转化。病例1是一名22岁的日本女性，随着耐药克隆的增加逐渐发生原始细胞转化，在她达到完全血液学缓解后细胞遗传学立即发生演变。病例2是一名24岁的日本男性，在甲磺酸伊马替尼治疗8个月且达到完全细胞遗传学反应后发生突然转化。虽然突然的原始细胞转化极为罕见，但即使在低风险、反应良好的患者中出现此类事件也凸显了通过敏感分析（如定量PCR）进行持续、严格监测的必要性。为了实现微小残留病的早期根除，在伊马替尼时代必须确定慢性髓性白血病的治疗策略，同时考虑目前唯一的治愈性治疗方法——异基因干细胞移植的应用。
