慢性骨髄性白血病のTKI治療による心血管系合併症への対応  [in Japanese] Management of cardiovascular complications in CML patients treated with tyrosine kinase inhibitors  [in Japanese]

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Author(s)

    • 松村 到 MATSUMURA Itaru
    • 近畿大学医学部 血液・膠原病内科 Kindai University Faculty of Medicine, Department of Hematology & Rheumatology

Abstract

<p>慢性骨髄性白血病の予後はチロシンキナーゼ阻害薬(TKI)の登場により画期的に改善した。しかし,TKIはBCR-ABL以外のoff-targetを阻害することにより,様々な副作用をもたらす。この中でも心血管系の閉塞症,肺高血圧症は重篤である。従って,CML患者にTKIを投与する際には,糖尿病,高血圧などの心血管系のリスク評価を行い,TKI投与中は心電図,心エコーなどの適切なモニタリングが必要である。</p>

<p>Tyrosine kinase inhibitors (TKIs) have significantly improved the clinical outcomes of patients with chronic myeloid leukemia (CML). However, patients with CML need to receive TKI therapy for several years. Hence, the safety of long-term TKI treatment warrants utmost attention. Among various adverse events caused by TKI therapy, cardiovascular events (CVEs), such as acute myocardial infarction, cerebral infarction, and pulmonary hypertension, are the most serious with high mortality. TKIs inhibit various off-target molecules involved in the occurrence of CVEs such as c-Kit, platelet-derived growth factor receptor (PDGFR), vascular endothelial growth factor receptor (VEGFR), and Tie-2/Tec. At present, nilotinib, dasatinib, and ponatinib, but not bosutinib, have been demonstrated to increase the risk of CVEs in patients with CML compared with imatinib. Conversely, patients with CML have also been shown to have high CVE risks regardless of the TKI treatment compared with non-cancer population. Hence, further analyses are required to deduce the influence of TKI treatment on CVEs. Whatever the cause may be, to prevent CVEs in patients with CML, we need to appropriately screen and monitor CVE risks such as hypertension, serum glucose, lipid levels, ankle-brachial index (ABI), Electrocardiography (ECG), and echocardiography before and during TKI treatment.</p>

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 59(1), 13-26, 2018

    The Japanese Society of Hematology

Codes

  • NII Article ID (NAID)
    130006337957
  • NII NACSIS-CAT ID (NCID)
    AN00252940
  • Text Lang
    JPN
  • ISSN
    0485-1439
  • NDL Article ID
    028820346
  • NDL Call No.
    Z19-295
  • Data Source
    NDL  J-STAGE 
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