Ramdial Jeremy L, Aguirre Luis E, Ali Robert A, Swords Ronan, Goodman Mark
Department of Hematology/Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
Department of Internal Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
Case Rep Hematol. 2019 Sep 22;2019:4861673. doi: 10.1155/2019/4861673. eCollection 2019.
Transient cytopenias and bone marrow hypoplasia commonly occur during treatment of CML with TKIs (tyrosine kinase inhibitors). This is usually related to the eradication of CML clones that initially compose the majority of hematopoietic cells in the bone marrow at the time of diagnosis. With continuation of effective therapy, normal blood counts return as normal hematopoiesis is restored and CML clones are reduced. Though rare and more unusual than myelodysplastic syndrome (MDS), isolated instances of persistent marrow aplasia have been documented with chronic use of TKIs. We describe two such instances of chronic phase CML where no significant reduction of CML clones was achieved following treatment with TKIs, but bone marrow aplasia occurred resulting in persistent dysfunctional hematopoiesis. Due to prolonged aplasia/hypoplasia, such patients are no longer amenable to TKI treatment. CML progression to accelerated or blast phase in that setting would likely be fatal.
在使用酪氨酸激酶抑制剂（TKIs）治疗慢性粒细胞白血病（CML）期间，常出现短暂性血细胞减少和骨髓发育不全。这通常与根除CML克隆有关，这些克隆在诊断时最初构成骨髓中大多数造血细胞。随着有效治疗的持续，正常血细胞计数会恢复，因为正常造血功能得以恢复且CML克隆减少。虽然与骨髓增生异常综合征（MDS）相比罕见且更不常见，但长期使用TKIs已记录到孤立的持续性骨髓再生障碍病例。我们描述了两例慢性期CML的此类病例，在用TKIs治疗后CML克隆未显著减少，但发生了骨髓再生障碍，导致持续性造血功能障碍。由于长期再生障碍/发育不全，此类患者不再适合接受TKI治疗。在这种情况下，CML进展为加速期或急变期可能是致命的。
