Objective
To evaluate the efficacy and safety of tyrosine kinase inhibitors (TKI) in treating the elderly patients with chronic myeloid leukemia (CML) during chronic phrase.
Methods
From January 2015 to January 2016, a total of 52 cases of chronic phrase CML patients who received TKI treatment, over 60-year-old and were treated at Department of Hematology, West China Hospital were included in this study. Thirty-three cases of them chose imatinib (IM) as the first-line treatment regimen and 2 cases of them chose nilotinib (NIL) as the first-line treatment regimen, while the other 17 cases were treated with interferon before IM. The therapeutic response, overall survival (OS), event-free survival (EFS), comorbidity and drug-related adverse reactions of all the patients were analyzed by retrospective method, in order to summarize the efficacy and safety of TKI in the treatment of CML in elderly patients.
Results
① The rates of cumulative complete hematologic response (CHR), major cytogenetic response (MCyR), complete cytogenetic response (CCyR) and major molecular response (MMR) were 100.0% (52/52), 82.7 % (43/52), 80.8 % (42/52) and 71.2 % (37/52), respectively. The rates of OS of 1-year, 5-year and 10-year were 100.0%, 95.1% and 75.3%, respectively, while the rates of EFS of 1-year, 5-year and 10-year were 92.3%, 73.3% and 51.4%, respectively. ② Twenty-five patients had comorbidities. The scores of Charlson comorbidity index (CCI) of these 52 patients were all less than 2 scores. There were no significant differences in the incidence of cumulative CCyR, MCyR, MMR, grade Ⅲ hematologic and non-hematologic adverse reactions between 32 patients with CCI score=0 and 20 patients with CCI score>0 (χ2=0.948, 0.525, 0.021, 0.288, 0.021; P>0.05). ③ In 50 patients who received treatment of IM, the incidence rates of Ⅲ-Ⅳ grade neutropenia, thrombocytopenia and anemia were 16.0 % (8/50), 28.0% (14/50) and 18.0% (9/50), respectively. While 14 patients occurred Ⅲ-Ⅳ grade non-hematologic adverse reactions, with the incidence rate of 28.0% (14/50). Due to intolerance of IM, 5 cases (10.0%, 5/50) of the patients received the second-line TKI treatment.
Conclusions
TKI is an effective and safe treatment for the elderly patients who have chronic phrase CML. Mild comorbidities have no influence on the therapy.
Key words:
Leukemia, myelogenous, chronic, BCR-ABL positive; Tyrosine kinase inhibitor; Aged; Drug-related side effects and adverse reactions; Comorbidity
Objective
To investigate the diagnosis and treatment of imatinib induced interstitial lung disease (ILD), providing clinical reference for early diagnosis, treatment and alternative medicine selection, and improving the prognosis of patients.
Methods
On 3 June 2016, a case of imatinib induced ILD who was admitted to Department of Hematology, West China Hospital, Sichuan University was included in this study. The patient was diagnosed with chronic myeloid leukemia (CML) and started therapy of imatinib on 15 December 2015. When the patient was admitted, bone marrow morphology, cytogenetic, medical imageological and pathological examination were conducted and diagnosis was made base on those test results and patient′s medical history and medication history. Then imatinib discontinued on 6 July 2016 and started 30 mg/d prednisone therapy on 29 July 2016 with 6-month duration. Switched to nilotinib 300 mg twice daily on 20 December 2016. Follow-up (up to 5 September 2017) was performed to monitor the efficacy. Clinical features, diagnosis and treatment of this patient were analyzed retrospectively, and related literatures were reviewed.
Results
① When the patient was admitted, results of bone marrow morphology, genetic examinations were all within normal range. Chest high resolution (HR) CT scan revealed lung marking increased, disordered, and blurred; and there were diffusely distributed multiple ground glass opacity, small patchy, and fibrous stripes. Results of lung puncture biopsy suggested chronic inflammation changed with fibrous tissue hyperplasia. ② Patient was diagnosed with imatinib-induced ILD. ③ Patient suspended imatinib were treated with prednisone, and the symptoms of cough and anhelation were significantly improved. After 6 weeks, the chest HRCT indicated a significant decrease in the bilateral lung lesions. After 6 months of nilotinib application, no significant abnormalities were observed in bone marrow morphology, genetic examination and HRCT results. And complete cytogenetic remission (CCyR) and deep molecular remission were achieved. The patient was well tolerated during follow-up.
Conclusions
The appearance of dyspnea after imatinib treatment should be considered the possibility of imatinib-induced ILD. Early diagnosis, discontinuation of imatinib and application of glucocorticoid can significantly improve prognosis of imatinib-induced ICD. In this case report, the patient with imatinib-induced ILD who was switched to nilotinib was well tolerated and CML treatment response was good, which could provide a reference for the clinical medication of CML.
Key words:
Imatinib; Interstitial pneumonia; Glucocorticoid; Nilotinib; Diagnosis
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