Mathisen Michael S, Kantarjian Hagop M, Cortes Jorge, Jabbour Elias J
M.D. Anderson Cancer Center, Department of Pharmacy, 1515 Holcombe BLVD, Unit 377, Houston, TX 77030, USA; M.D. Anderson Cancer Center, Department of Leukemia, 1515 Holcombe BLVD, Unit 428, Houston, TX 77030, USA.
M.D. Anderson Cancer Center, Department of Leukemia, 1515 Holcombe BLVD, Unit 428, Houston, TX 77030, USA.
Blood Rev. 2014 Sep;28(5):179-87. doi: 10.1016/j.blre.2014.06.001. Epub 2014 Jun 12.
The advent of tyrosine kinase inhibitors (TKIs) has drastically changed the treatment outcome of chronic myeloid leukemia (CML). Imatinib was the first TKI approved, and has been considered the standard of care for more than a decade. Second generation compounds, namely dasatinib and nilotinib, are highly effective in newly diagnosed patients as well as those who fail imatinib. Bosutinib and ponatinib have also become available as second line options. With five agents from which to choose, selecting a TKI has become a challenge. Multiple tests are now available to determine a patient's disease status, making the ideal monitoring strategy unclear. The gold standard for response to TKI therapy remains the achievement of complete cytogenetic response. This review will discuss the practical aspects of selecting a TKI and monitoring a patient once on therapy, including when to consider a treatment change. Other relevant issues, including cost, compliance, role of allogeneic hematopoietic cell transplantation, and discontinuation of TKIs will also be covered.
酪氨酸激酶抑制剂（TKIs）的出现极大地改变了慢性髓性白血病（CML）的治疗结果。伊马替尼是首个获批的TKI，十多年来一直被视为治疗的金标准。第二代化合物，即达沙替尼和尼洛替尼，对新诊断患者以及伊马替尼治疗失败的患者都非常有效。博舒替尼和普纳替尼也已作为二线选择药物。有五种药物可供选择，选择TKI已成为一项挑战。现在有多种检测方法可用于确定患者的疾病状态，这使得理想的监测策略尚不明晰。TKI治疗反应的金标准仍然是实现完全细胞遗传学反应。本综述将讨论选择TKI以及治疗期间监测患者的实际问题，包括何时考虑改变治疗方案。还将涵盖其他相关问题，包括成本、依从性、异基因造血细胞移植的作用以及TKI的停药等。
