Moura Muriel Silva, Benevides Thais Celi Lopes, Delamain Marcia Torresan, Duarte Gislaine Oliveira, Percout Priscila Oliveira, Dias Maria Almeida, Zulli Roberto, Souza Carmino Antonio de, Lorand-Metze Irene, Pagnano Katia Borgia Barbosa
Universidade Estadual de Campinas, (Unicamp), Campinas, SP, Brazil; Universidade Federal de Alagoas (UFAL), Maceio, AL, Brazil.
Universidade Estadual de Campinas, (Unicamp), Campinas, SP, Brazil; Universidade Federal de Campina Grande (UFCG), Campina Grande, PB, Brazil.
Hematol Transfus Cell Ther. 2019 Oct-Dec;41(4):329-334. doi: 10.1016/j.htct.2019.03.006. Epub 2019 Jun 14.
The incidence of grade 3-4 anemia was reported to be 3% with imatinib therapy for newly diagnosed chronic myeloid leukemia (CML) in the chronic phase (CP). However, there are few data regarding the causes and the development of anemia after long-term treatment. This study aimed to evaluate the incidence of anemia after at least two years of imatinib treatment of CML patients in the CP and to identify other contributing causes of anemia in this population.
We performed a retrospective analysis of 97 CML patients in the CP treated with imatinib for at least two years. We analyzed the hemoglobin (Hb) levels of CML patients at diagnosis, upon initiation of treatment with imatinib and after two years of imatinib treatment, and investigated other causes of anemia in this population.
Most of the patients presented Hb levels below the normal range (80.4%) after the second year of treatment, 17.9% grade 2 and 1.3% grade 3. In 13 cases (16.7%), anemia was attributed to resistance and in 13 cases (16.7%) the following causes were identified: iron deficiency (n=5), hypothyroidism (n=2), vitamin B12 deficiency (n=3), acquired immune deficiency syndrome (AIDS) (n=1), pulmonary tuberculosis (n=1) and renal toxicity (n=1). In 52 patients (66.6%), there were no other factors contributing to anemia, except imatinib treatment.
Regular follow-up is required to identify the causes of anemia not related to CML or imatinib toxicity. The importance of investigating secondary causes of anemia should be emphasized, especially in patients with good adherence to treatment and satisfactory therapeutic response.
据报道，在慢性期（CP）新诊断的慢性髓性白血病（CML）患者中，伊马替尼治疗导致3 - 4级贫血的发生率为3%。然而，关于长期治疗后贫血的原因及发展情况的数据较少。本研究旨在评估CP期CML患者接受伊马替尼治疗至少两年后贫血的发生率，并确定该人群中导致贫血的其他因素。
我们对97例接受伊马替尼治疗至少两年的CP期CML患者进行了回顾性分析。我们分析了CML患者诊断时、开始伊马替尼治疗时以及伊马替尼治疗两年后的血红蛋白（Hb）水平，并调查了该人群中贫血的其他原因。
大多数患者在治疗第二年时Hb水平低于正常范围（80.4%），其中17.9%为2级，1.3%为3级。在13例（16.7%）患者中，贫血归因于耐药，在13例（16.7%）患者中确定了以下原因：缺铁（n = 5）、甲状腺功能减退（n = 2）、维生素B12缺乏（n = 3）、获得性免疫缺陷综合征（AIDS）（n = 1）、肺结核（n = 1）和肾毒性（n = 1）。在52例（66.6%）患者中，除伊马替尼治疗外，没有其他导致贫血的因素。
需要定期随访以确定与CML或伊马替尼毒性无关的贫血原因。应强调调查贫血继发原因的重要性，特别是在治疗依从性良好且治疗反应满意的患者中。
