Respuesta al tratamiento con imatinib frente a nilotinib en pacientes con leucemia mieloide crónica en el Hospital SOLCA Guayaquil, análisis retrospectivo del año 2010 al 2015
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2016
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
Los inhibidores de la tirosina cinasa (ITC) incrementaron la prevalencia a nivel mundial de la leucemia mieloide crónica y por lo tanto los altos costos que implica mantener el tratamiento, en la actualidad existen protocolos internacionales para el manejo de la enfermedad y el uso correcto de estas nuevas dianas terapéuticas. El objetivo del estudio fue evaluar la respuesta al tratamiento con los ITC Imatinib y Nilotinib en pacientes con Leucemia Mieloide Crónica mediante la observación indirecta de los registros hematológicos, molecular y citogenético, en pacientes atendidos en el servicio de hematología entre el 2010 al 2015 en Solca Guayaquil y la evolución clínica del grupo de pacientes en función a los resultados obtenidos con el tratamiento. Se propuso un estudio retrospectivo, analítico, correlacional y transversal; el procesamiento, tabulación y análisis de la información se realizó tanto con el programa Excel 2013 y como el software Statistical Package of Social Sciencie (SPSS). De 105 pacientes registrados en este periodo fueron evaluables 54 historias clínicas con diagnostico confirmado. Se dividió a los pacientes en tres grupos, el primer grupo (31 pacientes) recibió imatinib como primera línea, el segundo grupo 11 pacientes que recibieron imatinib después de recibir tratamiento convencional con interferón alfa, citarabina o hidroxiurea por largo tiempo, y el tercer grupo de 12 pacientes, que recibió nilotinib como primera línea. Se excluyó a pacientes que no recibieron tratamiento con inhibidores de la tirosina cinasa y en fase blástica. 29 pacientes (53.7%) de la muestra fueron femeninos, 25 (46.3%) fueron hombres. Edad media 40 años (16 años – 79 años). La mediana de observación fue 26 meses (min 2 meses a 101 máx.). 37 pacientes (68%) se encontraban en fase crónica y 17 (31.48%) en fase acelerada. La Sobrevida Global fue 78% a 5 años, la sobrevida libre de progresión en 50% en 5 años. Del grupo imatinib 23 pacientes entraron en remisión, con sobrevida libre de progresión a 12 meses de 78%.
Inhibitors of tyrosine kinase (ITK) increased the worldwide prevalence of chronic myeloid leukemia and therefore the high costs of maintaining treatment, currently there are international protocols for disease management and proper use of these new therapeutic targets. The aim of the study was to evaluate the response to treatment with ITK Imatinib and Nilotinib in patients with chronic myeloid leukemia by the evolution of haematological, molecular and cytogenetic records, in patients treated at the hematology department from 2010 to 2015 in Solca Guayaquil clinical outcome of the patient according to the respond to treatment. Was analized a retrospective, analytical, correlational and cross-sectional study performed and analized data with both Excel 2013 program and as the Statistical Package for Social Sciencie (SPSS) software. 54 patients of 105 registered in this period were evaluated with confirmed diagnosis. He divided patients into three groups, the firts group 31 patients received Imatinib as first line, the second (11 patients) received Imatinib after receiving conventional treatment with alpha interferon, cytarabine or hydroxyurea long, and the third one (12 patients) received Nilotinib as a first line. Patients who received treatment with kinase inhibitors tyrosine and blastic phase were excluded. 29 patients (53.7%) were female, 25 patients (46.3%) were men. Mean age 40 years (16 years - 79 years). The median observation time was 26 months (min 2 months – 101 months max.). 37 patients (68%) were in chronic phase, 17 (31.48%) in accelerated phase. Overall survival was in 78% at 5 year, progression-free survival of 50% at 5 year. Imatinib group 23 patients went into remission, with progression-free survival at 12 months 78 %.
Inhibitors of tyrosine kinase (ITK) increased the worldwide prevalence of chronic myeloid leukemia and therefore the high costs of maintaining treatment, currently there are international protocols for disease management and proper use of these new therapeutic targets. The aim of the study was to evaluate the response to treatment with ITK Imatinib and Nilotinib in patients with chronic myeloid leukemia by the evolution of haematological, molecular and cytogenetic records, in patients treated at the hematology department from 2010 to 2015 in Solca Guayaquil clinical outcome of the patient according to the respond to treatment. Was analized a retrospective, analytical, correlational and cross-sectional study performed and analized data with both Excel 2013 program and as the Statistical Package for Social Sciencie (SPSS) software. 54 patients of 105 registered in this period were evaluated with confirmed diagnosis. He divided patients into three groups, the firts group 31 patients received Imatinib as first line, the second (11 patients) received Imatinib after receiving conventional treatment with alpha interferon, cytarabine or hydroxyurea long, and the third one (12 patients) received Nilotinib as a first line. Patients who received treatment with kinase inhibitors tyrosine and blastic phase were excluded. 29 patients (53.7%) were female, 25 patients (46.3%) were men. Mean age 40 years (16 years - 79 years). The median observation time was 26 months (min 2 months – 101 months max.). 37 patients (68%) were in chronic phase, 17 (31.48%) in accelerated phase. Overall survival was in 78% at 5 year, progression-free survival of 50% at 5 year. Imatinib group 23 patients went into remission, with progression-free survival at 12 months 78 %.
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Imatinib, Nilotinib, Leucemia mielógena crónica BCR-ABL positiva, Estudios retrospectivos, Hospital SOLCA de Guayaquil, Cantón Guayaquil, Ecuador