Vnitřní lékařství 4/2020

PŘEHLEDOVÉ ČLÁNKY Súčasné možnosti liečby BCR‑ABL1 pozitívnej chronickej myelocytovej leukémie u dospelých pacientov 224 | VNITŘNÍ LÉKAŘSTVÍ / Vnitř Lék 2020; 66(4): 214–224 /  www.casopisvnitrnilekarstvi.cz Záver Ešte pred vyše 3 desaťročiami bola CML fatálnym ochorením s me‑ diánom prežívania 4–6 rokov, s progresiou do blastovej fázy, ktorej prognóza je krajne nepriaznivá. Vývoj liečebných možností od alo‑ génnych transplantácií krvotvorných buniek v 90. rokoch 20. storočia smerom k cielenej terapii TKI po roku 2000 spôsobil prevrat v liečebnej stratégii, keďže zásadne došlo k predĺženiu celkového prežívania ako aj k zlepšeniu prognózy pacientov. V súčasnej modernej ére liečby CML dochádza len zriedka k progresii ochorenia do blastovej krízy, väčšina pacientov veľmi dobre reaguje na TKI, no problémom môže byť vznik nežiaducich účinkov dlhodobo podávanej terapie, ktoré môžu v niek‑ torých prípadoch limitovať adekvátne dávkovanie liekov. Na základe odporúčaní odborných spoločností ELN z roku 2013, ESMO z roku 2017 a NCCN pre rok 2019 máme možnosť v 1. línii liečby zvážiť u novodiagnostikovaného pacienta imatinib, dasatinib, nilotinib alebo bosutinib (14, 16, 55). Výber TKI závisí od stratifikácie rizika CML u individuálneho pacienta, jeho veku, komorbidít ako aj profilu nežiaducich účinkov zvažovaného TKI. Imatinib je lacnejší než druhogeneračné TKI a k dispozícii sú už generiká imatinibu, ktoré môžu znížiť ekonomické náklady na inak finančné náročnú dlhodobú terapiu v mnohých krajinách. Výzvou do budúcnosti je veľmi aktuálna problematika možnosti tzv. TFR, ktorá je nádejou aj pre mnohých pacientov s CML na možné vyliečenie ochorenia bez užívania TKI. LITERATÚRA 1. O’Brien S, Berman E, Moore JO et al. NCCN Task Force report: tyrosine kinase inhibitor therapy selection in the management of patients with chronic myelogenous leukemia. J Natl Compr Cancer Netw 2011; 9: (Suppl. 2): S1–S25. 2. 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