Ematologia con Trapianto, Università degli Studi di Bari Aldo Moro, Bari, Italy.
Haematologica. 2013 Mar;98(3):399-403. doi: 10.3324/haematol.2012.064337. Epub 2012 Jul 16.
There have been few reports of a response to dasatinib or nilotinib after failure of two prior sequential tyrosine kinase inhibitors. We report the outcome of 82 chronic phase patients who received nilotinib or dasatinib as third-line alternative tyrosine kinase inhibitor therapy. Thirty-four patients failed to respond to nilotinib and were started on dasatinib as third-line tyrosine kinase inhibitor therapy while 48 patients were switched to nilotinib after dasatinib failure. Overall, we obtained a cytogenetic response in 32 of 82 patients and major molecular response in 13 patients; disease progression occurred in 12 patients. At last follow up, 70 patients (85.4%) were alive with a median overall survival of 46 months. Our results show that third-line tyrosine kinase inhibitor therapy in chronic myeloid leukemia patients after failure of two prior sequential tyrosine kinase inhibitors may induce a response that, in some instances, could prolong overall survival and affect event-free survival.
在两种先前的序贯酪氨酸激酶抑制剂治疗失败后，仅有少数报道对达沙替尼或尼洛替尼有反应。我们报告了 82 例慢性期患者的结果，他们接受了尼洛替尼或达沙替尼作为三线替代酪氨酸激酶抑制剂治疗。34 例患者对尼洛替尼无反应，并开始接受达沙替尼作为三线酪氨酸激酶抑制剂治疗，而 48 例患者在达沙替尼治疗失败后转为尼洛替尼。总的来说，我们在 82 例患者中有 32 例获得细胞遗传学反应，13 例获得主要分子反应；12 例患者出现疾病进展。最后一次随访时，70 例（85.4%）患者存活，中位总生存期为 46 个月。我们的结果表明，在两种先前的序贯酪氨酸激酶抑制剂治疗失败后，慢性髓性白血病患者的三线酪氨酸激酶抑制剂治疗可能会诱导反应，在某些情况下可以延长总生存期并影响无事件生存期。
