酪氨酸激酶抑制剂一线治疗慢性髓系白血病的疗效、毒性及优化选用

张 宇曦1, 肖 健2, 肖 捷3, 黄 继贤4
1、汕头大学医学院附属粤北人民医院血液内科/韶关市中医院内科
2、汕头大学医学院附属粤北人民医院药学部
3、汕头大学医学院附属粤北人民医院体检中心
4、汕头大学医学院附属粤北人民医院血液内科

摘要


酪氨酸激酶抑制剂（TKI）的应用显著改善了慢性髓系白血病（CML）患者的预后，但终身治疗伴随的毒性反应影响生活质量。本文综述了一线TKI（伊马替尼、达沙替尼、尼洛替尼、博舒替尼、氟马替尼、阿思尼布）的疗效与毒性特征，分析其选用原则。二代TKI（如达沙替尼、尼洛替尼）较一代伊马替尼能更快实现深度分子学缓解，但毒性谱不同（如尼洛替尼的动脉闭塞事件、达沙替尼的胸腔积液）；三代TKI阿思尼布安全性更优。临床需结合患者年龄、合并症、治疗目标个体化选择TKI，通过剂量调整或换药管理毒性，以平衡疗效与生活质量。

关键词


慢性髓系白血病；酪氨酸激酶抑制剂；一线治疗；疗效；毒性；个体化治疗

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参考


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