Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA, USA.
Yale University School of Medicine, 300 Cedar Street, PO Box 208057, New Haven, CT, USA.
Blood Rev. 2018 Jul;32(4):289-299. doi: 10.1016/j.blre.2018.01.004. Epub 2018 Feb 3.
Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm, the incidence of which increases with age. Tyrosine kinase inhibitors (TKIs) are the mainstay of CML treatment, including imatinib, nilotinib, dasatinib, bosutinib, and ponatinib. Beyond matching patient disease profiles with TKI specificity, differences in the efficacy and toxicity profiles and a patient's comorbid risk factors should be considered when selecting the most appropriate agent. Our objectives are to review the incidence and severity of cardiovascular, metabolic, and pulmonary disorders associated with these TKIs, highlighting differences in adverse event profiles, suggested risk-mitigation strategies, and guidance for TKI selection in different settings. Patients receiving TKI agents for CML should be monitored for signs and symptoms of toxicity throughout therapy. Preemptive assessment, early toxicity recognition, and prompt management of cardiovascular, metabolic, and pulmonary toxicities can minimize treatment-limiting complications and improve outcomes in patients with CML.
慢性髓性白血病（CML）是一种骨髓增生性肿瘤，其发病率随着年龄的增长而增加。酪氨酸激酶抑制剂（TKI）是 CML 治疗的主要方法，包括伊马替尼、尼洛替尼、达沙替尼、博舒替尼和帕纳替尼。在选择最合适的药物时，除了要使患者的疾病特征与 TKI 的特异性相匹配外，还应考虑疗效和毒性特征以及患者的合并症危险因素的差异。我们的目标是回顾与这些 TKI 相关的心血管、代谢和肺部疾病的发生率和严重程度，强调不良事件谱的差异、建议的风险缓解策略以及不同情况下 TKI 选择的指导。接受 TKI 治疗 CML 的患者应在整个治疗过程中监测毒性的迹象和症状。对心血管、代谢和肺部毒性进行预防性评估、早期毒性识别和及时管理，可以最大限度地减少治疗限制并发症并改善 CML 患者的结局。
