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晚期慢性髓性白血病:困难治疗情况的选择

Ehab Atallah¹, Michael Deininger²

¹Division of Hematology & Oncology, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA. eatallah@mcw.edu.

|December 5, 2024

概括

加速和爆发期慢性髓性白血病 (CML) 是这种疾病的罕见,激进的形式. 目前针对加速/爆发期CML的治疗策略依赖于有限的数据和不断变化的分类,而全源干细胞移植具有治愈潜力.

科学领域:

血液学血液学血液学
在瘤学瘤学.
白血病研究研究白血病研究

背景情况:

慢性髓性白血病 (CML) 在4-7%的患者中可以进展到攻击性加速阶段 (AP) 或爆发阶段 (BP).
BP-CML通常是髓状,但可以是淋巴状血统.
由于AP/BP-CML的罕见性,有限的临床试验数据和不断变化的诊断分类,治疗决策变得复杂.

研究的目的:

审查有关加速期 (AP) 和爆发期 (BP) 慢性髓性白血病 (CML) 患者治疗方法的现有数据.

主要方法:

回顾性图表审查和早期氨酸激酶抑制剂 (TKI) 研究数据的分析.
检查AP/BP-CML不断变化的诊断标准,包括世界卫生组织 (WHO) 和国际共识分类 (ICC) 的定义.
影响治疗的因素的评估,如先前的治疗,BCR::ABL1突变,并发症,细胞系,以及异构干细胞移植 (alloHCT) 资格等.

主要成果:

在呈现时AP-CML可能有良好的预后没有alloHCT如果对治疗有反应.
对于TKI耐火性AP-CML或任何BP-CML,alloHCT是主要的治疗选择.
治疗策略是个性化的,基于多个患者和疾病特异性因素.

结论:

优化AP/BP-CML的管理需要仔细考虑患者特异性因素和可用的治疗选择.
异构干细胞移植仍然是晚期CML阶段的关键治疗方式.
需要进一步的研究,为这些罕见的CML亚型制定基于证据的指南.

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