Practical management of side effects of tyrosine kinase inhibitor therapy in chronic myeloid leukemia

Osszefoglalo. A kronikus myeloid leukaemia ritka, klonalis őssejt eredetű betegseg. A myeloid sejtsor koros műkodeset a 9-es es 22-es kromoszomak reciprok transzlokacioja kovetkezteben kialakulo fuzios gen (BCR/ABL1) altal kodolt patologias (fokozott) aktivitasu tirozin-kinaz jelatviteli feherje okozza. A tartos, gyakran elethosszig tarto BCR/ABL1 specifikus tirozin-kinaz-gatlo (TKI-) kezeles a betegek jelentős hanyadaban az egeszseges populacio tuleleset elerő teljes gyogyulast biztosit, melyhez folyamatos, a mindenkori szakmai ajanlasoknak megfelelő onkohematologiai ellenőrzes szukseges. Az igen hatekony TKI-kezeles mellett azonban nemkivanatos mellekhatasok jelentkezhetnek, melyek - szamos szervrendszert erintve - a kronikus myeloid leukaemias beteg kezeleset multidiszciplinaris egyuttműkodesse szelesitik ki. Jelenleg Magyarorszagon otfele TKI erhető el, melyek mellekhatasprofilja igen elterő. A kezeles elinditasakor, illetve terapiamodositas eseten beteg- es korkepspecifikus szempontokat merlegelve kell kivalasztani az adott TKI-kezelest. Tekintettel a tartos kezeles mellett elerhető kivalo tulelesi eredmenyekre, egyre gyakoribb azoknak a kronikus myeloid leukaemias betegeknek a szama, akiknel valtozo sulyossagu nemkivanatos mellekhatasok jelentkeznek, melyek miatt a betegek sokszor nem a hematologus szakorvosnal jelentkeznek. A leggyakrabban eszlelt szovődmenyek ismerteteset sajat beteganyagunk reszletes elemzese kapcsan a mindennapi klinikai gyakorlatban is bemutatjuk. Igen fontos, hogy a tarsszakmak (haziorvos, belgyogyasz, kardiologus, angiologus, diabetologus, tudőgyogyasz, gasztroenterologus stb.) gyakorloi is tisztaban legyenek az adott TKI-kezeles lehetseges mellekhatasaival, azok megelőzesevel, időben tortenő felismeresevel es hatekony kezelesevel. Szakmai kozreműkodesuk reven igy segithetik a klinikai hematologust a megfelelő terapia megtervezeseben, valamint a betegek folyamatos kezelese kapcsan gyakran szuksegesse valo szakmaspecifikus gondozasaban is. Orv Hetil. 2021; 162(30): 1198-1207. Summary. Chronic myeloid leukemia is a rare clonal stem cell disorder. The pathological overproduction of the myeloid cell line is caused by abnormal function of a tyrosine kinase encoded by a fusion gene (BCR/ABL1) which is formed upon a reciprocal translocation of chromosomes 9 and 22. Long-term, often lifelong treatment with BCR/ABL1-specific tyrosine kinase inhibitors provides excellent disease control and overall survival rates close to the general survival of a healthy population in a significant proportion of patients. These patients require continuous oncohematological monitoring in accordance with the current diagnostic and treatment guidelines. However, undesirable side effects may occur that extend the treatment of the patients to a multidisciplinary approach involving a number of nonhematological specialities. Currently, five types of tyrosine kinase inhibitors are available in Hungary, with very different side effect profiles. At the start of treatment or in the event of a change in therapy, patient- and leukemia-specific assessments should be taken to select the most proper tyrosine kinase inhibitors treatment. Given the excellent survival outcomes achieved with long-term tyrosine kinase inhibitor treatment, there is an increasing number of patients who might experience adverse events of different kind or severity, which often results in patients ending up in different, nonhematological medical situations. The description of the most frequently observed complications in connection with a detailed cross-sectional analysis of our own patient cohort is also presented here resembling everyday clinical practice. It is very important that practitioners of other medical professions (general practitioner, internist, cardiologist, angiologist, diabetologist, pulmonologist, gastroenterologist, etc.) should be aware of the possible side effects of specific tyrosine kinase inhibitor therapies. They can help to assist the clinical hematologist in planning the appropriate tyrosine kinase inhibitor therapy as well as in professional caretaking of these patients. Orv Hetil. 2021; 162(30): 1198-1207.