Fujiwara Shin-Ichiro, Shirato Yuya, Ikeda Takashi, Kawaguchi Shin-Ichiro, Toda Yumiko, Ito Shoko, Ochi Shin-Ichi, Nagayama Takashi, Mashima Kiyomi, Umino Kento, Minakata Daisuke, Nakano Hirofumi, Morita Kaoru, Yamasaki Ryoko, Kawasaki Yasufumi, Sugimoto Miyuki, Ashizawa Masahiro, Yamamoto Chihiro, Hatano Kaoru, Sato Kazuya, Oh Iekuni, Ohmine Ken, Muroi Kazuo, Kanda Yoshinobu
Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
Int J Hematol. 2018 Jun;107(6):712-715. doi: 10.1007/s12185-017-2378-y. Epub 2017 Nov 28.
Tyrosine kinase inhibitors (TKIs) are standard therapy for chronic myeloid leukemia (CML). However, the effects of these agents on mature B cell lymphoma are not well known. We describe a 50-year-old man who was diagnosed with CML in the chronic phase and treated with imatinib. After 3 years of imatinib therapy that achieved a complete cytogenetic response of CML, he developed Philadelphia-negative follicular lymphoma (FL). Rituximab monotherapy induced a partial response of FL, and he subsequently achieved a major molecular response (MMR) of CML. Three years later, however, the MMR was lost, followed by the progression of FL. Imatinib was switched to nilotinib for the treatment of CML, while we chose watchful waiting for FL. He achieved MMR again under treatment with nilotinib for 8 months including one month of substitutional use of dasatinib due to adverse events, but thereafter nilotinib was switched to bosutinib due to hyperbilirubinemia. With the administration of second-generation TKIs (2G-TKIs) for a total of 18 months, he achieved a complete response to FL without antilymphoma treatment. This is the first report to suggest that 2G-TKIs may have direct or indirect effects on FL.
酪氨酸激酶抑制剂（TKIs）是慢性髓性白血病（CML）的标准治疗药物。然而，这些药物对成熟B细胞淋巴瘤的影响尚不清楚。我们描述了一名50岁男性，他在慢性期被诊断为CML，并接受伊马替尼治疗。在伊马替尼治疗3年使CML达到完全细胞遗传学缓解后，他发生了费城染色体阴性的滤泡性淋巴瘤（FL）。利妥昔单抗单药治疗诱导了FL的部分缓解，随后他达到了CML的主要分子学缓解（MMR）。然而，3年后，MMR丧失，随后FL进展。伊马替尼换用尼罗替尼治疗CML，而对于FL我们选择观察等待。在尼罗替尼治疗8个月（包括因不良事件替换使用达沙替尼1个月）期间，他再次达到MMR，但此后由于高胆红素血症，尼罗替尼换用了波舒替尼。在总共18个月的第二代TKIs（2G-TKIs）治疗后，他在未进行抗淋巴瘤治疗的情况下达到了FL的完全缓解。这是首份提示2G-TKIs可能对FL有直接或间接作用的报告。
