Department of Medicine, Unity Hospital, Rochester Regional Health, New York, New York, USA.
Department of Medical Oncology/Hematology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar.
Oncology. 2024;102(4):380-388. doi: 10.1159/000534266. Epub 2023 Oct 17.
Viral infections remain a significant problem for patients with chronic myeloid leukemia (CML) who undergo stem cell transplants (SCTs). These infections often result from the reactivation of latent viruses. However, our understanding of the risk of viral reactivation in CML patients who have not undergone SCT is limited, and there is a scarcity of data on this topic. Tyrosine kinase inhibitors (TKIs) have revolutionized the treatment of CML as it is highly successful and has transformed the prognosis of patients with CML. However, TKI may be associated with an increased risk of infections.
We have performed a literature search for publications related to viral infections and their reactivations in patients with CML using PubMed, Scopus, and Google Scholar for the period 2001-2022. The population consisted of patients over 18 years old with a diagnosis of CML and no history of bone marrow transplantation. In an analysis of 41 patients, with 25 males and 16 females, M:F ratio of 1.56:1, and a median age of 50. Age ranged from 22 to 79 years. Most patients with reported viral infections or reactivations were in the chronic phase (CP) of CML, with 22 patients (76%) in the CP, 6 patients (21%) in the accelerated phase, and 1 patient (3%) in the blast phase. Most cases with reported outcomes responded to treatment for CML; only one had refractory disease and 8 cases (32%) had major molecular response. Imatinib was the most used TKI in 31 patients (77%). The most reported viral reactivations were herpes zoster in 17 cases (41%), followed by hepatitis B reactivation in 15 cases (37%).
This review sheds light on the importance of having a hepatitis B serology checked before starting TKI therapy and close monitoring for viral infections and reactivations in patients with CML.
对于接受干细胞移植 (SCT) 的慢性髓性白血病 (CML) 患者，病毒感染仍然是一个重大问题。这些感染通常是由潜伏病毒的激活引起的。然而，我们对未接受 SCT 的 CML 患者中病毒再激活的风险了解有限，并且关于这个主题的数据很少。酪氨酸激酶抑制剂 (TKI) 的出现彻底改变了 CML 的治疗方法，因为它的疗效非常高，改变了 CML 患者的预后。然而，TKI 可能与感染风险增加有关。
我们使用 PubMed、Scopus 和 Google Scholar 对 2001 年至 2022 年期间与 CML 患者的病毒感染及其再激活相关的出版物进行了文献检索。该人群由 18 岁以上、诊断为 CML 且无骨髓移植史的患者组成。在对 41 例患者（25 名男性和 16 名女性）的分析中，M:F 比为 1.56:1，中位年龄为 50 岁。年龄范围从 22 岁到 79 岁。大多数报告有病毒感染或再激活的患者处于 CML 的慢性期 (CP)，22 例（76%）处于 CP，6 例（21%）处于加速期，1 例（3%）处于急变期。大多数报告的结果对 CML 治疗有反应；只有 1 例为难治性疾病，8 例（32%）有主要分子反应。31 例患者（77%）使用了伊马替尼作为最常用的 TKI。报告的再激活病毒中，带状疱疹最多见，共 17 例（41%），其次是乙型肝炎再激活，共 15 例（37%）。
本综述强调了在开始 TKI 治疗前检查乙型肝炎血清学以及密切监测 CML 患者的病毒感染和再激活的重要性。
