Jootar Saengsuree
Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand.
Hematology. 2012 Apr;17 Suppl 1:S72-4. doi: 10.1179/102453312X13336169155772.
CML in Asia seems to affect the younger age group and more patients are in the high and intermediate Sokal risk group. Cytogenetic study and molecular testing are done mostly at diagnosis, but monitoring the response is limited due to the cost and accessibility. The treatment of chronic phase CML has changed dramatically within the last decade and imatinib has become the standard treatment for CP, CML. Since the cost of imatinib is quite high, most Asian patients cannot afford it. Patients in several countries get imatinib through Glivec International Patient Assistant Program. Patients who are intolerant or resistant to imatinib usually get the second generation tyrosine kinase inhibitors (TKIs), either nilotinib or dasatinib. The National Health Insurance covers all or most of the cost of imatinib in South Korea, Hong Kong and Taiwan. Both nilotinib and dasatinib are partially or fully covered by national insurance in Australia, Japan, Singapore and Taiwan as the second-line therapy. TKIs treatment remains out of reach for many Asian CML patients, especially those in the rural areas and those who are not eligible for patient access programs or covered by the national insurance. The cytogenetic response to imatinib in Asian CML patients varies considerably, from as low as 24% to as high as 96%. The Asia CML Study Alliance was briefly presented.
亚洲的慢性粒细胞白血病似乎影响较年轻的年龄组，更多患者处于索卡尔高风险和中风险组。细胞遗传学研究和分子检测大多在诊断时进行，但由于成本和可及性，对治疗反应的监测有限。在过去十年中，慢性期慢性粒细胞白血病的治疗发生了巨大变化，伊马替尼已成为慢性期慢性粒细胞白血病的标准治疗药物。由于伊马替尼成本相当高，大多数亚洲患者负担不起。几个国家的患者通过格列卫国际患者援助计划获得伊马替尼。对伊马替尼不耐受或耐药的患者通常会使用第二代酪氨酸激酶抑制剂（TKIs），即尼罗替尼或达沙替尼。韩国、香港和台湾的国民健康保险涵盖了伊马替尼的全部或大部分费用。在澳大利亚、日本、新加坡和台湾，尼罗替尼和达沙替尼作为二线治疗药物部分或全部由国家保险覆盖。酪氨酸激酶抑制剂治疗对许多亚洲慢性粒细胞白血病患者来说仍然遥不可及，尤其是农村地区的患者以及那些没有资格参加患者救助计划或未被国家保险覆盖的患者。亚洲慢性粒细胞白血病患者对伊马替尼的细胞遗传学反应差异很大，低至24%，高至96%。文中简要介绍了亚洲慢性粒细胞白血病研究联盟。
