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Empfehlungen zur Verlaufskontrolle und Zweitlinientherapie bei der chronischen myeloischen Leukämie (CML)

Recommendations on monitoring and second-line therapy for chronic myeloid leukemia

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Zusammenfassung

Die Prognose der Patienten mit chronischer myeloischer Leukämie (CML) hängt in erster Linie vom im Therapieintervall erreichten Remissionsgrad ab. Die Behandlung der CML erfordert deshalb systematische Verlaufskontrollen, um ein suboptimales Ansprechen oder ein Therapieversagen frühzeitig zu erkennen und um therapeutische Maßnahmen einleiten zu können. Trotz der beeindruckenden Wirksamkeit von Imatinib benötigen einige Patienten in chronischer Phase im Verlauf der Behandlung eine alternative Therapie. Als Zweitlinientherapie bei Imatinib-Versagen oder -Unverträglichkeit stehen die Tyrosinkinasehemmer Nilotinib und Dasatinib zur Verfügung. Beide Substanzen zeigen eine hohe Wirksamkeit. Welches der beiden Medikamente im individuellen Fall als Zweitlinientherapie bevorzugt werden sollte, kann anhand des individuellen Patientenstatus, der Nebenwirkungsprofile und der unterschiedlichen Wirksamkeit von Nilotinib und Dasatinib bei bestimmten BCR-ABL-Mutationen entschieden werden. Die Indikation zur allogenen Stammzelltransplantation sollte bei Imatinib-Versagen in jedem Fall geprüft werden. In dieser Publikation werden aktuelle Empfehlungen zur Methodik und Frequenz von Verlaufsanalysen bei CML diskutiert und Unterschiede zwischen Nilotinib und Dasatinib aufgezeigt, die als Entscheidungsgrundlage für eine optimale Therapiewahl dienen können.

Abstract

The prognosis for patients with chronic myeloid leukemia (CML) is dependent on the degree of remission achieved within a specific time frame. Regular assessments are necessary for early recognition of patients with suboptimal response or treatment failure, so that the therapeutic strategy can be adapted accordingly. Despite the impressive results obtained with imatinib some patients in the chronic phase will require an alternative therapy during the course of treatment. In the case of imatinib failure or intolerance, the tyrosine kinase inhibitors nilotinib and dasatinib are approved second-line therapies and both are highly effective. The choice of which agent to select as the optimal second-line therapy should be based on individual patient status, the different side-effect profiles of these two agents and the different efficacies in the presence of specific BCR-ABL mutations. In the case of imatinib failure allogeneic stem cell transplantation should also be considered as a therapeutic option. This article discusses current recommendations on monitoring frequency and methods in CML as well as differences between nilotinib and dasatinib, which can guide clinicians in selecting an optimal second-line therapy.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Alle Autoren erhielten Beraterhonorare für die Teilnahme an Advisory Board Meetings von Novartis. A.H., P.C. und T.H. erhielten zusätzlich Beraterhonorare von Bristol-Myers Squibb und Forschungsgelder von Novartis. Die Manuskripterstellung wurde durch Novartis unterstützt. Die Autoren bestätigen, dass die Aussagen entweder evidenzbasiert sind oder unabhängige Expertenmeinung darstellen.

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Authors and Affiliations

  1. Abteilung Hämatologie/Onkologie, Universitätsklinikum Jena, Erlanger Allee 101, 07740, Jena, Deutschland

    A. Hochhaus

  2. Praxis und Tagesklinik für Internistische Onkologie und Hämatologie, Recklinghausen, Deutschland

    F. Overkamp

  3. Abteilung Hämatologie/Onkologie, Universitätsklinikum Leipzig, Leipzig, Deutschland

    T. Lange

  4. Gemeinschaftspraxis Onkologie Lerchenfeld, Hamburg, Deutschland

    A. Mohr

  5. Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Deutschland

    O. Ottmann

  6. Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Deutschland

    P. Coutre

  7. MLL Münchner Leukämie Labor GmbH, München, Deutschland

    T. Haferlach

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  1. A. Hochhaus
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  2. F. Overkamp
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  3. T. Lange
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  4. A. Mohr
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  7. T. Haferlach
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Correspondence to A. Hochhaus.

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Hochhaus, A., Overkamp, F., Lange, T. et al. Empfehlungen zur Verlaufskontrolle und Zweitlinientherapie bei der chronischen myeloischen Leukämie (CML). Onkologe 16, 701–708 (2010). https://doi.org/10.1007/s00761-010-1894-7

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