地西他滨、地塞米松联合尼洛替尼+达沙替尼治疗伴T315A,F359I,M244V突变慢性髓细胞白血病急淋变  

Chronic myeloid leukemia in lymphoblastic crisis with ABL1 kinase mutation (T315A/F359I/M244V) treated by decitabine,dexamethason combined with nilotinib and dasatinib:a case report

作　　者：王素丽[1] 何耀[1] 朱雨[1] 朱华渊[1] 沈文怡[1] 龙启强[1] 何广胜[1] 李建勇[1] 

机构地区：[1]南京医科大学第一附属医院江苏省人民医院,南京210029

出　　处：《临床血液学杂志》2016年第1期57-59,共3页Journal of Clinical Hematology

基　　金：国家科技公关项目(No:2014BAI09B12);南京医科大学第一附属医院创新团队课题;江苏省医学重点项目(No:BL2014086);南京市医学科技发展项目(No:YKK14153);江苏省普通高校优势学科(No:JX10231801)

摘　　要：目的:报道地西他滨、地塞米松联合尼洛替尼+达沙替尼治疗慢性髓细胞白血病急淋变1例。方法:对1例伴T315A,F359I,M244V慢性髓细胞白血病急淋变患者,给予地西他滨、地塞米松联合尼洛替尼+达沙替尼双TKIs治疗,并进行血常规、骨髓形态、病理免疫组织化学、染色体核型和分子生物学检测评价疗效。结果:治疗期间患者一般情况逐渐好转,血常规逐步恢复,未出现严重感染。复查骨髓形态:骨髓增生明显活跃,原幼淋占2.0%;染色体:46,XX[20];RQ-PCR检测BCR-ABL(RAW%)8.98%;ABL激酶区突变检测T315A,F359I,M244V突变阳性。结论:地西他滨、地塞米松联合尼洛替尼+达沙替尼成功诱导了耐药的慢性髓细胞白血病急淋变患者达血液学及细胞遗传学缓解,耐受性良好。Objective：To report one patient in blast phase of chronic myeloid leukemia associated with T315A/F359I/M244 V compound mutation treated by decitabine,dexamethason combined with nilotinib and dasatinib.Method：The patient received decitabine 20mg/m2 for over 1hour daily on days 1to 5,and dexamethasone 10 mg daily on days 1to 10.Meanwhile,the patient was given oral nilotinib 400 mg and dasatinib 70 mg daily.Result：After treatment,she achieved a complete hematologic response once again with only 2.0%immature cells discovered in the bone marrow smear.The frequency of BCR-ABL（P210）fusion gene was 8.98%.The chromosomal karyotypes was normal.T315 A,F359I,M244 V mutations were still positive.Conclusion：Combining decitabine,dexamethason with dasatinib and nilotinib could promote TKI resistant-chronic myeloid leukemia to achieve complete hematologic response and cytogenetic response with a well tolerance.

关 键 词：白血病 髓细胞 慢性 T315A F359I M244V 耐药 急淋变 地西他滨 

分 类 号：R733.72[医药卫生—肿瘤]