Sobash Philip T, Guddati Achuta K, Kota Vamsi
Internal Medicine, White River Health System, Batesville, AR, USA.
Medical Oncology, Augusta University, Augusta, GA, USA.
Case Rep Oncol Med. 2020 Apr 6;2020:4936846. doi: 10.1155/2020/4936846. eCollection 2020.
Ruxolitinib has become a new therapeutic option for steroid refractory graft-versus-host disease (srGVHD), with a substantial remission rate. Its anti-inflammatory properties by blocking interleukin pathways have made it a novel therapeutic approach to inflammatory disease processes, such as GVHD. The long-term use of ruxolitinib has not been explicitly studied outside the context in the treatment of multiple myeloma. With current clinical trials underway for the use of ruxolitinib in srGVHD, there are still no current guidelines or protocols for long-term clinical use. Of the available literature showing ruxolitinib utilization for srGVHD, most cases lead to resolution and eventual discontinuation. We present a case of a 32-year-old male on ruxolitinib with GVHD status postmatched unrelated donor stem cell transplant (MUD SCT) for acute myeloid leukemia (AML) with FLT3 mutation currently on ruxolitinib for 5 years who is not able to tolerate reduction in dosage due to flare-ups. We discuss the clinical implications and nuance of therapy with ruxolitinib with unknown long-term effects and weigh the risks and benefits.
鲁索替尼已成为类固醇难治性移植物抗宿主病（srGVHD）的一种新的治疗选择，缓解率颇高。其通过阻断白细胞介素通路发挥的抗炎特性，使其成为治疗诸如GVHD等炎症性疾病过程的一种新型治疗方法。在多发性骨髓瘤治疗背景之外，尚未对鲁索替尼的长期使用进行明确研究。鉴于目前正在进行鲁索替尼用于srGVHD的临床试验，目前仍没有长期临床使用的指南或方案。在现有显示鲁索替尼用于srGVHD的文献中，大多数病例病情得到缓解并最终停药。我们报告一例32岁男性，因急性髓系白血病（AML）伴FLT3突变接受了匹配无关供体干细胞移植（MUD SCT），目前使用鲁索替尼治疗GVHD已达5年，因病情突然发作无法耐受剂量减少。我们讨论了鲁索替尼治疗的临床意义及细微差别，其长期影响未知，并权衡了风险与益处。
