Tuberculosis complicating imatinib treatment for chronic myeloid leukaemia
Tuberculosis complicating imatinib treatment for chronic myeloid leukaemia
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DOI：
10.1183/09031936.00025408
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发表时间：
2009-03-01
影响因子：
24.3
通讯作者：
van Altena, R.
中科院分区：
文献类型：
--
作者：
Daniels, J. M. A.;Vonk-Noordegraaf, A.;van Altena, R.
虽然伊马替尼不被认为是结核病（TB）的易感因素，本病例报告描述了3例慢性粒细胞白血病伊马替尼治疗并发TB的患者。这就提出了伊马替尼是否会增加对结核病的易感性的问题。有几份报告表明伊马替尼可能会损害免疫系统，导致各种感染，包括水痘带状疱疹和B型肝炎。健康个体中的TB控制通过获得性免疫来实现，其中抗原特异性T细胞和巨噬细胞阻止结核分枝杆菌的生长并维持对持久性杆菌的控制。在感染的慢性阶段，CD8+ T细胞协助巨噬细胞控制细胞内分枝杆菌。酪氨酸激酶在T细胞受体信号转导中起重要作用，伊马替尼已被证明影响T细胞受体信号转导，这一事实提出了伊马替尼可能损害结核分枝杆菌控制的机制，从而使宿主对结核病的再活化敏感。
Although imatinib is not considered a predisposing factor for tuberculosis (TB), the present case report describes three patients in whom imatinib treatment for chronic myeloid leukaemia was complicated by TB. This raises the question of whether imatinib increases susceptibility to TB.There are several reports suggesting that imatinib might impair the immune system, leading to a variety of infections, including varicella zoster and hepatitis B. Control of TB in healthy individuals is achieved through acquired immunity, in which antigen-specific T-cells and macrophages arrest growth of Mycobacterium tuberculosis bacilli and maintain control over persistent bacilli. In the chronic stage of the infection, CD8+ T-cells assist macrophages in controlling intracellular mycobacteria. The T-cell receptor orchestrates this process.The fact that tyrosine kinases play an important role in T-cell receptor signal transduction and that imatinib has been shown to affect T-cell receptor signal transduction, presents a mechanism by which imatinib might impair control of Mycobacterium tuberculosis; thereby leaving the host susceptible to reactivation of tuberculosis.