Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, Texas.
Am J Hematol. 2016 Jan;91(1):59-66. doi: 10.1002/ajh.24249.
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. Second generation TKIs have been demonstrated to induce deeper and faster responses compared to imatinib, however no survival advantage has been observed so far. Today, the expected survival of CML patients, if properly managed, is likely to be similar to the general population. Clinicians are faced the challenge of making decision for which TKI to choose upfront. Comorbidities of the patient, the side effect profile, and the cost of the TKI of interest should be an important consideration in decision making. Whatever TKI is chosen as frontline, noncompliance or treatment failure should be recognized early as a prompt intervention increases the chance of achieving best possible response. Herein, we review the frontline options for the management of patients with CML and how to best choose these agents.
酪氨酸激酶抑制剂（TKI）的出现极大地改变了慢性髓性白血病（CML）的治疗结果。伊马替尼是第一种获得批准的 TKI，并且在十多年来一直被认为是治疗标准。第二代化合物，即达沙替尼和尼洛替尼，在新诊断的患者以及对伊马替尼耐药的患者中都非常有效。与伊马替尼相比，第二代 TKI 已被证明能诱导更深和更快的反应，但迄今为止尚未观察到生存优势。如今，如果得到适当的管理，CML 患者的预期生存时间可能与普通人群相似。临床医生面临着为患者选择哪种 TKI 作为一线治疗的决策挑战。患者的合并症、副作用谱和感兴趣的 TKI 的成本应是决策中的重要考虑因素。无论选择哪种 TKI 作为一线治疗，都应及早识别不依从或治疗失败，因为及时干预可增加获得最佳反应的机会。在此，我们综述了 CML 患者管理的一线治疗选择，以及如何最好地选择这些药物。
