Deng Qian, Wang Erhua, Wu Xinyu, Cheng Qian, Liu Jing, Li Xin
Department of Hematology, Third Hospital of Xiangya, Central South University, Changsha 410013, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2020 Jul 28;45(7):874-880. doi: 10.11817/j.issn.1672-7347.2020.190116.
Chronic myeloid leukemia (CML) is one of the most common hematological malignancies and characterized by the formation of Philadelphia (Ph) chromosome. Recently, tyrosine kinase inhibitors (TKI) treatment greatly improved the prognosis of CML. However, the options may be limited when a patient develops traditional TKI resistance or gene mutation. Herein, we reported a case. A 38-year-old male CML patient developed a BCR-ABL1 gene mutation of T315I after 2.5 years of TKI treatment, including imatinib and dasatinib. We adjusted the treatment with the combined application of dasatinib and axitinib. BCR-ABL1 gene copies dropped down and achieved an early molecular response at 2 months later. Subsequently, he received hematopoietic stem cell transplantation. Axitinib and dasatinib were applied for another half year after the allogeneic hematopoietic stem cell transplantation (allo-HSCT). Two years after the allo-HSCT, the BCR-ABL1 gene was still undetectable. It provided a successful example in treating CML patients carrying BCR-ABL1 T315I mutation via combination of axitinib with conditional TKI.
慢性髓性白血病（CML）是最常见的血液系统恶性肿瘤之一，其特征是形成费城（Ph）染色体。最近，酪氨酸激酶抑制剂（TKI）治疗极大地改善了CML的预后。然而，当患者出现传统TKI耐药或基因突变时，治疗选择可能会受到限制。在此，我们报告一例病例。一名38岁男性CML患者在接受包括伊马替尼和达沙替尼在内的TKI治疗2.5年后出现了T315I的BCR-ABL1基因突变。我们调整治疗方案，联合应用达沙替尼和阿昔替尼。2个月后，BCR-ABL1基因拷贝数下降并实现了早期分子反应。随后，他接受了造血干细胞移植。异基因造血干细胞移植（allo-HSCT）后，继续应用阿昔替尼和达沙替尼半年。allo-HSCT两年后，仍未检测到BCR-ABL1基因。这为通过阿昔替尼与条件性TKI联合治疗携带BCR-ABL1 T315I突变的CML患者提供了一个成功范例。
