Characteristics of patients with development of large granular lymphocyte expansion among dasatinib-treated patients with relapsed Philadelphia chromosome-positive acute lymphoblastic leukemia after allogeneic stem cell transplantation.
Characteristics of patients with development of large granular lymphocyte expansion among dasatinib-treated patients with relapsed Philadelphia chromosome-positive acute lymphoblastic leukemia after allogeneic stem cell transplantation.
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DOI：
10.1016/j.clml.2014.09.006
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发表时间：
2015-03
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通讯作者：
Yoshikiyo Ito;T. Miyamoto;T. Kamimura;K. Aoki;H. Henzan;T. Aoki;M. Shiratsuchi;Koji Kato;K. Nagafuji;R. Ogawa;T. Eto;H. Iwasaki;K. Akashi
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作者：
Yoshikiyo Ito;T. Miyamoto;T. Kamimura;K. Aoki;H. Henzan;T. Aoki;M. Shiratsuchi;Koji Kato;K. Nagafuji;R. Ogawa;T. Eto;H. Iwasaki;K. Akashi
酪氨酸激酶抑制剂（tyrosine kinase inhibitors，TKIs）联合化疗和异基因造血干细胞移植（allogene hematopoietic stem cell transplantation，allo-SCT）的广泛应用彻底改变了费城染色体阳性急性淋巴细胞白血病（Ph+ALL）的现有治疗策略。然而，复发后的预后allo-SCT仍然是dumble.Patients和MethodsWe分析了使用达沙替尼，第二代TKI，在9例复发Ph+ALL患者的临床治疗结果后，allo-SCT。达沙替尼开始在中位时间为168天后，异基因造血干细胞移植的剂量范围从20毫克至100毫克daily.ResultsSix的9例患者表现出显着增加大颗粒淋巴细胞（LGL），但所有6例患者停止达沙替尼，因为不良事件（AE），如胸腔积液。4 6例患者恢复达沙替尼，其中3人一直活着的分子完全缓解和持续增加的LGLs.ConclusionOur结果表明，达沙替尼治疗可以诱导LGL扩张伴随着AE，但这种现象可以与长期生存的好处在一定比例的复发Ph+ALL患者异基因SCT后。
IntroductionWidespread use of tyrosine kinase inhibitors (TKIs) in combination with chemotherapy and allogeneic hematopoietic stem cell transplantation (allo-SCT) has totally changed the existing treatment strategies for Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL). However, the prognosis after relapse after allo-SCT is still dismal.Patients and MethodsWe analyzed the clinical outcome of therapy using dasatinib, a second-generation TKI, in 9 patients with relapsed Ph+ALL after allo-SCT. Dasatinib was initiated at a median time of 168 days after allo-SCT at dosages ranging from 20 mg to 100 mg daily.ResultsSix of 9 patients manifested a marked increase in large granular lymphocytes (LGLs), but all 6 patients discontinued dasatinib because of adverse events (AEs) such as pleural effusion. Four of 6 patients resumed dasatinib, and 3 of them have been alive with molecular complete remission and a persistent increase of LGLs.ConclusionOur results demonstrated that dasatinib therapy can induce LGL expansion accompanied by AEs, but this phenomenon can be associated with long-term survival benefit in a proportion of relapsed Ph+ALL patients after allo-SCT.