Naka Ryosuke, Shimomura Yoshimitsu, Miura Masatomo, Nagai Yuya, Kondo Tadakazu, Ishikawa Takayuki
Department of Hematology, Kobe City Hospital Organization Kobe City Medical Center General Hospital, Minamimati 2-1-1, Minatojima, Chuo-ku, Kobe, 650-0047, Japan.
Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan.
Int J Hematol. 2025 Feb;121(2):272-275. doi: 10.1007/s12185-024-03869-y. Epub 2024 Nov 7.
The advent of tyrosine kinase inhibitors (TKIs) has revolutionized the treatment of chronic myeloid leukemia (CML), significantly improving patient prognosis. Asciminib, a novel specifically targeting the ABL myristoyl pocket inhibitor, has shown promise for CML patients unresponsive or intolerant to traditional TKIs. However, its use in hemodialysis patients remains underexplored. We present a case of a 71-year-old man with CML undergoing hemodialysis, successfully treated with asciminib. Initial treatment with bosutinib was effective but later failed, prompting a switch to asciminib. The patient achieved a major molecular response within 2 months without adverse effects. Pharmacokinetic analysis revealed significant drug clearance during hemodialysis, necessitating dosage adjustments. This case highlights the potential of asciminib in managing CML in hemodialysis patients, emphasizing the need for individualized treatment plans and close monitoring. Further studies are warranted to establish comprehensive guidelines for asciminib use in this unique patient population.
酪氨酸激酶抑制剂（TKIs）的出现彻底改变了慢性粒细胞白血病（CML）的治疗方式，显著改善了患者的预后。阿塞西尼布是一种新型的特异性靶向ABL肉豆蔻酰口袋抑制剂，对传统TKIs无反应或不耐受的CML患者显示出了治疗前景。然而，其在血液透析患者中的应用仍未得到充分探索。我们报告了一例71岁接受血液透析的CML男性患者，使用阿塞西尼布成功治疗的病例。最初使用波舒替尼治疗有效，但后来失败，促使改用阿塞西尼布。该患者在2个月内实现了主要分子反应，且无不良反应。药代动力学分析显示血液透析期间药物清除显著，需要调整剂量。该病例突出了阿塞西尼布在治疗血液透析患者CML中的潜力，强调了制定个体化治疗方案和密切监测的必要性。有必要进行进一步研究，以建立针对这一特殊患者群体使用阿塞西尼布的综合指南。
