Labrador Jorge, Hermida Gerardo J, Alvarez Rodolfo, Anso Victor, de Vicente Pilar, Goñi Mercedes, Gonzalez-Lopez Tomas Jose
Department of Hematology, University Hospital of Burgos, Burgos, Spain.
Case Rep Hematol. 2020 Nov 11;2020:8867461. doi: 10.1155/2020/8867461. eCollection 2020.
Blast crisis (BC) continues to be the major challenge in the treatment of chronic myeloid leukemia. Best results have been observed in a few patients who were successfully transplanted after returning to chronic phase. Recent studies focus on the combination of chemotherapy with imatinib, but results remain unsatisfactory. Since dasatinib induces deeper and faster responses, a reasonable strategy might be to combine it with chemotherapy, taking into account the alterations in T-cell response induced by dasatinib. However, there are no published studies or case reports supporting the use of dasatinib as first line treatment for initial myeloid BC, and very little is known about infectious complications associated with this drug. Based on this, we present the case of a patient diagnosed with an initial nonlymphoid phenotype BC, who achieved molecular response (MR) with dasatinib and FLAG-IDA, but he suffered a pulmonary aspergillosis, CMV infection, and a CMV reactivation, prior to an allogeneic hematopoietic stem cell transplantation (HSCT). In conclusion, dasatinib and FLAG-IDA is an effective therapy for initial BC. However, a warning call is needed owing to the high risk of opportunistic infections, such as CMV.
急变期（BC）仍然是慢性髓性白血病治疗中的主要挑战。在少数回到慢性期后成功进行移植的患者中观察到了最佳疗效。近期研究聚焦于化疗与伊马替尼的联合使用，但结果仍不尽人意。由于达沙替尼能诱导更深度、更快速的反应，考虑到达沙替尼诱导的T细胞反应变化，一种合理的策略可能是将其与化疗联合使用。然而，尚无已发表的研究或病例报告支持将达沙替尼用作初发髓系BC的一线治疗，且对于与该药物相关的感染并发症知之甚少。基于此，我们报告一例诊断为初发非淋巴细胞表型BC的患者，该患者使用达沙替尼和FLAG-IDA方案后获得了分子学缓解（MR），但在异基因造血干细胞移植（HSCT）前发生了肺曲霉病、巨细胞病毒（CMV）感染及CMV再激活。总之，达沙替尼和FLAG-IDA方案是初发BC的有效治疗方法。然而，鉴于CMV等机会性感染的高风险，需要发出警示。
