Současné možnosti léčby u pacientů s chronickou myeloidní leukemií

Title in English Current treatment options in patients with chronic myeloid leukemia


Year of publication 2020
Type Article in Periodical
Magazine / Source Farmakoterapie
MU Faculty or unit

Faculty of Medicine

Keywords chronic myeloid leukemia
Description Treatment of chronic myeloid leukemia (CML) involves the administration of highly potent tyrosine kinase inhibitors (TKIs). The vast majority of patients with chronic phase CML achieve a major molecular response (MMR) with TKI, which is associated with long-term survival corresponding to the survival of the general population. Imatinib and nilotinib are currently available in the Czech Republic as first-line treatment. Compared to imatinib, nilotinib as a second-generation TKI allows a faster molecular response to be achieved more rapidly, but at the cost of higher toxicity. Therefore, nilotinib is the treatment of choice, especially in younger patients, in whom the achievement of a stable deep molecular response allows subsequent discontinuation of TKI administration. Long-term maintenance of molecular remission of CML after discontinuation of TKI administration is possible in approximately 30 to 40% of patients. In patients with molecular disease progression, it is necessary to return the TKI to medication. In elderly patients, imatinib is predominantly selected in the first line, which has less serious side effects and is safer to administer in the long term. During treatment and after discontinuation of TKI, patients are monitored at regular intervals by examination of the BCR-ABL1 transcript level by polymerase chain reaction (PCR). Patients showing resistance or intolerance are indicated to change TKI to 2nd and subsequent line. The choice of TKI in such a case depends on the result of the mutational analysis of the BCR-ABL1 kinase domain and also on the age and comorbidities of the patient. The goal of 2nd and subsequent line treatment is to re-achieve and maintain MMR for a long time while minimizing the side effects of TKI. Severe prognosis is associated with advanced stages of CML, the treatment of which remains a challenge even in the era of TKI.

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