Takagi Yuri, Aota Yasuo, Gotoh Akihiko, Sakurai Michio
Dept. of Internal Medicine, Kohsei Chuo General Hospital.
Gan To Kagaku Ryoho. 2010 Nov;37(11):2213-5.
We experienced a case of chronic myelogenous leukemia (CML) treated successfully with low-dose dasatinib (20 mg/day). An 87-year-old man was diagnosed with CML in January 2003 and was given imatinib (200 mg/day). Although complete hematologic responses (CHR) were achieved, we replaced imatinib with hydroxycarbamide (HU) because of the renal dysfunction possibly due to imatinib. However, since the blood count was poorly controlled with HU, treatment with dasatinib, one of the second-generation tyrosine kinase inhibitors, was started at the accelerated phase (AP) in June 2009. Dasatinib was given in a daily dose of 20 mg, intending dose escalation after confirmation of its safety. White blood cells and platelets decreased rapidly, and after 18 days, CHR was achieved. Thereafter, daily dasatinib was reduced twice per week because of the cytopenia. However, the patient has continued CHR without developing AP for more than six months. Low-dose dasatinib might be a useful treatment in the control of selected patients with CML.
我们遇到了一例用低剂量达沙替尼(20毫克/天)成功治疗的慢性粒细胞白血病(CML)患者。一名87岁男性于2003年1月被诊断为CML,并接受伊马替尼(200毫克/天)治疗。虽然实现了完全血液学缓解(CHR),但由于可能因伊马替尼导致的肾功能不全,我们将伊马替尼换成了羟基脲(HU)。然而,由于HU对血细胞计数控制不佳,2009年6月在加速期(AP)开始使用第二代酪氨酸激酶抑制剂之一的达沙替尼进行治疗。达沙替尼的给药剂量为每日20毫克,在确认其安全性后打算逐步增加剂量。白细胞和血小板迅速下降,18天后实现了CHR。此后,由于血细胞减少,达沙替尼的每日剂量每周减少两次。然而,该患者持续保持CHR,超过六个月未进展至AP。低剂量达沙替尼可能是控制部分CML患者的一种有用治疗方法。