University of Turin, Turin, Italy.
Clin Lymphoma Myeloma Leuk. 2012 Apr;12(2):79-87. doi: 10.1016/j.clml.2011.12.004. Epub 2012 Jan 28.
Vigilant monitoring of a patient's response to current treatment is imperative to the management of chronic myeloid leukemia (CML). Early identification of treatment failure may increase the probability that alternative therapy will be effective. This review discusses the use of molecular monitoring in the timely detection of failure of imatinib treatment. Changes in the levels of BCR-ABL transcripts are predictive of response or relapse. Patients achieving a major molecular response (MMR) within 12 months of treatment may experience longer cytogenetic remission. Accumulating evidence also suggests that lower transcript levels observed ≤ 6 months after the start of treatment are associated with improved patient outcomes. For patients with primary or secondary imatinib resistance (or intolerance), dasatinib or nilotinib may be prescribed. These agents have demonstrated activity in patients harboring imatinib-resistant BCR-ABL mutations, except for the T315I substitution.
对慢性髓性白血病（CML）的治疗管理而言，密切监测患者对当前治疗的反应至关重要。早期发现治疗失败可能会增加替代治疗有效的可能性。这篇综述讨论了分子监测在及时检测伊马替尼治疗失败中的应用。BCR-ABL 转录本水平的变化可预测反应或复发。治疗 12 个月内达到主要分子反应（MMR）的患者可能会经历更长的细胞遗传学缓解。越来越多的证据还表明，治疗开始后≤6 个月时观察到的较低转录水平与改善患者预后相关。对于原发性或继发性伊马替尼耐药（或不耐受）的患者，可能会开达沙替尼或尼洛替尼。这些药物在携带伊马替尼耐药 BCR-ABL 突变的患者中显示出活性，除了 T315I 取代。
