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Dasatinib as the salvage therapy for chronic myeloid leukemia with blast crisis and central nervous system involvement: A case report

机译:达沙替尼作为伴有爆炸危险和中枢神经系统受累的慢性粒细胞白血病的挽救疗法:一例报告

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摘要

BCR-ABL tyrosine-kinase inhibitors are the first-line therapy for the majority of patients with chronic myelogenous leukemia (CML). Up to 20% of patients who have imatinib-treated CML in blast crisis (BC) experience a relapse in the central nervous system (CNS) due to the poor penetration of the drug by the blood-brain barrier. The present case reports a successful experience of using dasatinib-based combination therapy to treat a 22-year-old female who presented with initial symptoms of intermittent fever and easy bruising under the diagnosis of CML in BC. Although the patient eventually succumbed to profound sepsis, the CNS involvement was treated successfully using dasatinib-based combination therapy (cranial radiation and de-escalated intrathecal chemotherapy). This case demonstrates that dasatinib may be a viable option for those who are not medically fit for or are otherwise unwilling to receive high-dose chemotherapy. It appears that dose intensity is essential for optimal efficacy and should be maintained at 150 mg daily as far as possible.
机译:BCR-ABL酪氨酸激酶抑制剂是大多数慢性粒细胞性白血病(CML)患者的一线治疗方法。在爆炸风险(BC)中接受伊马替尼治疗的CML的患者中,多达20%的患者由于血脑屏障对药物的渗透性差而导致中枢神经系统(CNS)复发。本病例报道了使用基于达沙替尼的联合疗法治疗22岁女性的成功经验,该女性在BC的CML诊断下表现出间歇性发热和容易瘀伤的初始症状。尽管患者最终屈服于严重的败血症,但使用基于达沙替尼的联合治疗(颅骨放疗和鞘内降级化疗)成功治疗了中枢神经系统受累。该病例表明,达沙替尼对于那些医学上不适合或不愿接受大剂量化疗的患者可能是一个可行的选择。似乎剂量强度是获得最佳疗效必不可少的,应尽可能保持每天150 mg。

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