Department of Medicine, Division of Hematology/Oncology (Oncology Center), College of Medicine and King Khalid University Hospital, King Saud University, P.O. Box 2378, Riyadh, 11472, Saudi Arabia.
Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Al-Ahsa, Saudi Arabia.
Int J Hematol. 2023 Aug;118(2):288-291. doi: 10.1007/s12185-023-03569-z. Epub 2023 Mar 9.
Patients with newly diagnosed chronic-phase chronic myeloid leukemia (CP-CML) can develop cytopenias secondary to bone marrow hypoplasia after starting tyrosine kinase inhibitor (TKI) therapy. These adverse effects are usually transient, but cytopenias can persist in some patients. TKI-associated thrombocytopenia can develop in a significant proportion of CML patients and may require TKI dose reduction or dose interruptions. The thrombopoietin receptor agonist eltrombopag may improve thrombocytopenia in these patients, but the supporting literature for this approach is limited. Herein, we describe the case of a 56-year-old woman who developed persistent TKI-associated thrombocytopenia and intracranial hemorrhage. She could not tolerate full doses of imatinib and she failed to achieve a major molecular response (MMR). She responded to eltrombopag and platelet count improved, which allowed commencement and continuation of dasatinib as second-line TKI therapy, resulting in achievement of MMR. TKI-associated thrombocytopenia can cause serious bleeding and may also interfere with the management of CML by necessitating TKI dose interruption or reduction. Use of eltrombopag can help maintain adequate platelet counts and uninterrupted delivery of TKI therapy.
新诊断的慢性期慢性髓性白血病（CP-CML）患者在开始酪氨酸激酶抑制剂（TKI）治疗后，可能会因骨髓再生不良而出现细胞减少症。这些不良反应通常是短暂的，但在一些患者中可能会持续存在。TKI 相关性血小板减少症可在相当一部分 CML 患者中发生，可能需要减少 TKI 剂量或中断 TKI 治疗。血小板生成素受体激动剂艾曲波帕可能改善这些患者的血小板减少症，但这种方法的支持文献有限。本文描述了一位 56 岁女性的病例，她出现持续性 TKI 相关性血小板减少症和颅内出血。她不能耐受伊马替尼的全剂量，也未能达到主要分子反应（MMR）。她对艾曲波帕有反应，血小板计数有所改善，这使得达沙替尼作为二线 TKI 治疗得以开始和持续进行，从而达到 MMR。TKI 相关性血小板减少症可引起严重出血，还可能因需要中断或减少 TKI 剂量而干扰 CML 的管理。使用艾曲波帕可帮助维持足够的血小板计数并不间断地进行 TKI 治疗。
