García-Gutiérrez Valentín, Hernández-Boluda Juan Carlos
Servicio de Hematología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.
Servicio de Hematología, Hospital Clínico Universitario, Institute of Health Research (INCLIVA), Valencia, Spain.
Front Oncol. 2019 Jul 3;9:603. doi: 10.3389/fonc.2019.00603. eCollection 2019.
Chronic myeloid leukemia (CML) is currently a disease in which patients can enjoy a near normal life-expectancy. However, since the majority of patients will need to remain on treatment indefinitely, physicians in care of CML patients need be familiar with the indications and toxicities of all approved tyrosine kinase inhibitors (TKI). In clinical practice, there are five TKI (imatinib, nilotinib, dasatinib, bosutinib, and ponatinib) that are available in different scenarios and have distinct safety profiles. Decisions regarding first line treatment must be based on CML risk, comorbidities, and patients expectations. Despite the excellent outcome, half of the patients will eventually fail (due to intolerance or resistance) to first line treatment, with many of them requiring a third or even further lines of therapy. When selecting for such patients, it is essential to distinguish between failure and intolerance to previous TKIs. In the present review, we will address all these issues from a practical point of view.
慢性髓性白血病（CML）目前是一种患者有望享有接近正常预期寿命的疾病。然而，由于大多数患者需要无限期接受治疗，负责治疗CML患者的医生需要熟悉所有已批准的酪氨酸激酶抑制剂（TKI）的适应证和毒性。在临床实践中，有五种TKI（伊马替尼、尼洛替尼、达沙替尼、博舒替尼和波纳替尼）可用于不同情况，且具有不同的安全性特征。关于一线治疗的决策必须基于CML风险、合并症和患者期望。尽管治疗效果良好，但一半的患者最终会（由于不耐受或耐药）一线治疗失败，其中许多患者需要三线甚至更后续的治疗。在为这类患者选择治疗方案时，区分对先前TKI的治疗失败和不耐受至关重要。在本综述中，我们将从实际角度探讨所有这些问题。
