Heym Kenneth M, Gressett Ussery Sarah M, Trinkman Heidi, Philpot Lindsey M
*Department of Hematology/Oncology, Cook Children's Medical Center, Fort Worth †Medical Science Liaison-Hematology, Celgene Corporation ‡Office of the Chief Quality Officer, Baylor Scott & White Health, Dallas TX.
J Pediatr Hematol Oncol. 2015 Mar;37(2):e111-3. doi: 10.1097/MPH.0000000000000277.
Therapy with the tyrosine kinase inhibitor imatinib mesylate has become standard initial treatment for adult and pediatric patients with chronic myelogenous leukemia. Long-term follow-up data are now available in the adult population, and the toxicity profile of imatinib mesylate among adults has been extensively studied and reported. Despite its increasing use in the pediatric population, there are limited data regarding adverse event profiles of imatinib mesylate in children, and few reports exist in the literature focusing on nonhematologic toxicity in this population. We reviewed our institutional experience with imatinib therapy for chronic myelogenous leukemia over an 8-year period of time. Nine pediatric patients began therapy with imatinib mesylate and were included in this review. We reviewed the occurrence of nonhematologic toxicity in this cohort and the impact of that toxicity on continuation of therapy. Eight patients experienced nonhematologic toxicity, including nausea/vomiting (44.4%) and musculoskeletal pain (88.9%). Three patients (33.3%) required discontinuation of imatinib therapy due to grade 3/4 musculoskeletal pain, a rate that is significantly higher than that seen in the adult population. As imatinib therapy becomes increasingly widespread in the treatment of pediatric malignancies, there may be different patterns of clinically significant nonhematologic toxicity, including higher grade musculoskeletal pain.
酪氨酸激酶抑制剂甲磺酸伊马替尼已成为成人和儿童慢性粒细胞白血病患者的标准初始治疗方法。目前已有成人患者的长期随访数据，并且甲磺酸伊马替尼在成人中的毒性特征已得到广泛研究和报道。尽管其在儿科人群中的使用越来越多，但关于甲磺酸伊马替尼在儿童中的不良事件特征的数据有限，而且文献中很少有专注于该人群非血液学毒性的报告。我们回顾了我们机构在8年时间里使用伊马替尼治疗慢性粒细胞白血病的经验。9名儿科患者开始使用甲磺酸伊马替尼治疗并纳入本综述。我们回顾了该队列中非血液学毒性的发生情况以及该毒性对治疗持续时间的影响。8名患者出现非血液学毒性，包括恶心/呕吐（44.4%）和肌肉骨骼疼痛（88.9%）。3名患者（33.3%）因3/4级肌肉骨骼疼痛而需要停用伊马替尼治疗，这一比例明显高于成人人群。随着伊马替尼治疗在儿科恶性肿瘤治疗中越来越广泛，可能会出现不同模式的具有临床意义的非血液学毒性，包括更高级别的肌肉骨骼疼痛。
