Heaney Mark L
Columbia University -Medical Center, New York, New York.
Clin Adv Hematol Oncol. 2014 Aug;12(8):502-8.
Columbia University -Medical Center, New York, New York. The advent of tyrosine kinase inhibitors (TKIs) as primary treatment in chronic myeloid leukemia (CML) has greatly changed expectations of both physicians and patients. The use of imatinib has led not only to reliable cytogenetic responses, but also to deeper "molecular" responses that have brought long-term survival to a disease that was generally lethal in patients who were not candidates for stem cell transplantation. The more recent entrée of second-generation TKIs-nilotinib, dasatinib, bosutinib, and ponatinib-as well as the protein synthesis inhibitor omacetaxine, has provided access to more potent agents. These new drugs provide a safety net for patients whose disease does not respond to imatinib, but also create dilemmas for physicians treating CML patients. This review examines the evidence that informs choice of initial therapy, and discusses management options in the context of new goals of care, emerging toxicities, and the possibility of discontinuing treatment.
纽约哥伦比亚大学医学中心。酪氨酸激酶抑制剂（TKIs）作为慢性髓性白血病（CML）的一线治疗药物问世后，极大地改变了医生和患者的预期。伊马替尼的使用不仅带来了可靠的细胞遗传学反应，还产生了更深层次的“分子”反应，使这种在不适合干细胞移植的患者中通常致命的疾病实现了长期生存。第二代TKIs（尼罗替尼、达沙替尼、博舒替尼和波纳替尼）以及蛋白质合成抑制剂奥马西他辛的新近应用，提供了更有效的药物。这些新药为疾病对伊马替尼无反应的患者提供了保障，但也给治疗CML患者的医生带来了困境。本综述审视了指导初始治疗选择的证据，并在新的治疗目标、新出现的毒性以及停药可能性的背景下讨论了管理方案。
