2nd Department of Internal Medicine, Division of Hematolgy, University Hospital Hradec Králové, Czech Republic.
Neoplasma. 2011;58(3):256-62. doi: 10.4149/neo_2011_03_256.
Tyrosine kinase inhibitors (TKI) have completely changed the prognosis of patients with Ph+ chronic myeloid leukemia (CML). The occurrence of a second malignancy (SM) in CML patients successfully treated with TKI may significantly affect their prognosis. In a retrospective study of 1,038 patients with CML treated at 10 centers in the Czech Republic and Slovakia between 2000 and 2009, SM was detected in 35 (3.37%) patients after TKI therapy was initiated. The median intervals from the diagnosis of CML and from the start of TKI therapy to the diagnosis of SM were 58 months (range 2 - 214) and 32 months (range 1 - 102), respectively. The observed age-standardized incidence of SM after the start of TKI therapy was 8.95 / 1,000 person-years. Comparison of the incidence of SM in CML patients with population data was performed only for patients from the Czech Republic. The age-standardized incidence rate of all malignant tumors except non-melanoma skin cancers was 6.76 (95% CI: 6.74; 6.78) / 1,000 person-years in 2000 - 2007 while the incidence rate of SM in 708 CML patients from the Czech Republic treated with TKI was 9.84 (95% CI: 6.20; 13.48) / 1,000 person-years, i.e. 1.5-fold higher, although the difference was statistically insignificant. The distribution of SM types in CML patients treated with TKI was similar to that in the age-standardized general Czech population. The median overall survival (OS) of patients treated with TKI who also developed SM (57 months) was shorter than the OS of patients treated with TKI but not suffering from SM (median OS not reached, log rank test p < 0.001. Prospective long-term population-based studies in CML patients treated with TKI as first-line therapy are needed to determine the relationship of SM to KTI therapy.
酪氨酸激酶抑制剂 (TKI) 彻底改变了 Ph+ 慢性髓性白血病 (CML) 患者的预后。在成功接受 TKI 治疗的 CML 患者中，第二种恶性肿瘤 (SM) 的发生可能会显著影响其预后。在捷克共和国和斯洛伐克 10 个中心对 2000 年至 2009 年期间接受治疗的 1038 例 CML 患者进行的回顾性研究中，在开始 TKI 治疗后，有 35 例 (3.37%) 患者检测到 SM。从 CML 诊断到开始 TKI 治疗再到 SM 诊断的中位间隔分别为 58 个月（范围 2-214）和 32 个月（范围 1-102）。开始 TKI 治疗后 SM 的观察到的年龄标准化发病率为 8.95/1000 人年。仅对来自捷克共和国的 CML 患者进行了 SM 发病率与人群数据的比较。除非黑素瘤皮肤癌外，2000-2007 年所有恶性肿瘤的年龄标准化发病率为 6.76（95%CI：6.74；6.78）/1000 人年，而在捷克共和国接受 TKI 治疗的 708 例 CML 患者中，SM 的发病率为 9.84（95%CI：6.20；13.48）/1000 人年，即发病率增加了 1.5 倍，尽管差异无统计学意义。接受 TKI 治疗的 CML 患者中 SM 类型的分布与年龄标准化的捷克普通人群相似。同时患有 SM 的接受 TKI 治疗的患者的中位总生存期（OS）（57 个月）短于未患有 SM 的接受 TKI 治疗的患者的 OS（中位 OS 未达到，对数秩检验 p<0.001）。需要对接受 TKI 作为一线治疗的 CML 患者进行前瞻性长期基于人群的研究，以确定 SM 与 TKI 治疗的关系。
