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低剂量波纳替尼维持治疗下所有Ph+患者中的T315I克隆选择

T315I clone selection in a Ph+ all patient under low-dose ponatinib maintenance.

作者信息

Noetzli Jasmine, Gavillet Mathilde, Masouridi-Levrat Stavroula, Duchosal Michel, Spertini Olivier

机构信息

Service and Central Laboratory of Hematology University Hospital of Lausanne (CHUV) Lausanne Switzerland.

Hematology Hôpitaux Universitaires de Genève (HUG) Genève Switzerland.

出版信息

Clin Case Rep. 2017 Jul 3;5(8):1320-1322. doi: 10.1002/ccr3.1032. eCollection 2017 Aug.

DOI:10.1002/ccr3.1032
PMID:28781850
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5538043/
Abstract

We report here the clinical course of a Ph+ ALL patient who was treated with ponatinib 15 mg/day, as maintenance therapy, and developed a BCR-ABL T315I mutation leading to ALL relapse. This clonal evolution was reversed, without adverse effects, by increasing ponatinib to 45 mg/day. To our knowledge, we have been confronted with the first clinical case of a T315I clonal selection of ALL caused by subeffective therapeutic level of the drug. This single patient experience highlights the risk of T315I clone selection in Ph+ ALL treated with reduced dose ponatinib.

摘要

我们在此报告一名Ph+急性淋巴细胞白血病（ALL）患者的临床病程，该患者接受每日15毫克泊那替尼作为维持治疗，发生了BCR-ABL T315I突变，导致ALL复发。通过将泊那替尼剂量增加至每日45毫克，这种克隆进化得以逆转，且无不良反应。据我们所知，我们遇到了首例因药物治疗水平未达有效剂量导致ALL出现T315I克隆选择的临床病例。这一单一患者的经历凸显了在接受低剂量泊那替尼治疗的Ph+ ALL中T315I克隆选择的风险。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b564/5538043/b655cc48566d/CCR3-5-1320-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b564/5538043/b655cc48566d/CCR3-5-1320-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b564/5538043/b655cc48566d/CCR3-5-1320-g001.jpg

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本文引用的文献

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Lancet Haematol. 2015 Sep;2(9):e376-83. doi: 10.1016/S2352-3026(15)00127-1.
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Complicated and Advanced Atherosclerosis in a Young Woman With Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia: Success and Challenges of BCR/ABL1-Targeted Cancer Therapy.一名费城染色体阳性急性淋巴细胞白血病年轻女性的复杂晚期动脉粥样硬化：BCR/ABL1靶向癌症治疗的成功与挑战
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