Repuesta al tratamiento en leucemia mieloide crónica refractaria mediante cuantificación del Gen BCR/ABL1
Fecha
2018
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
Los pacientes con leucemia mieloide crónica reciben tratamiento con terapia dirigida de primera línea que son los inhibidores de tirosina cinasa de primera y segunda generación, pero pueden presentar refractariedad por mutaciones puntuales en el gen BCR/ABL1. Objetivo. Determinar la respuesta terapéutica con inhibidores de tirosina cinasa, en pacientes con leucemia mieloide crónica refractaria, mediante la cuantificación del gen BCR/ABL1 en el hospital Dr. Teodoro Maldonado Carbo, periodo 2013 - 2017. Materiales y métodos. Se realizó un estudio correlacional, no experimental, transversal, que incluyó pacientes con leucemia mieloide crónica refractarios al tratamiento de primera línea, y que recibieron tratamiento de segunda línea con imatinib o nilotinib y dosis aumentadas de los mismos. Resultados. El 67,7% de los pacientes fueron de sexo masculino; la edad promedio fue 50 años de edad, el 87% fue en fase crónica; el 41,9% fue riesgo alto e intermedio respectivamente y un 10% de pacientes fallecieron. Los 31 pacientes fueron clasificados en 4 grupos de tratamiento: G1: imatinib/nilotinib, un 67,7%; G2: nilotinib/imatinib, 3,2%; G3: imatinib/dosis aumentada imatinib, 22,6%; y G4: nilotinib/dosis aumentada nilotinib, 6,5%. La prueba McNemar, demostró en pacientes refractariedad a la primera línea de tratamiento con Imatinib, pero mejoró su respuesta con el Nilotinib como segunda línea de tratamiento. Conclusiones. Se obtuvo diferencias estadísticamente significativas que demuestra la efectividad del nilotinib en pacientes con resistencia a imatinib, previniendo la progresión de la enfermedad, lo cual fue posible comprobar con la cuantificación del gen BCR/ABL1, siendo de utilidad para determinar la respuesta en el tratamiento.
Palabras clave: Biología molecular, Leucemia Mieloide Crónica, PCR.
Patients with chronic myeloid leukemia receive treatment with first-line targeted therapy, which are the first and second generation tyrosine kinase inhibitors, but may present refractoriness due to point mutations in the BCR / ABL1 gene. Objective. To determine the therapeutic response with tyrosine kinase inhibitors, in patients with refractory chronic myeloid leukemia, by quantification of the BCR / ABL1 gene in the Dr. Teodoro Maldonado Carbo hospital, period 2013 - 2017. Materials and methods. A correlational, non-experimental, cross-sectional study was performed, which included patients with chronic myeloid leukemia refractory to first-line treatment, and who received second-line treatment with imatinib or nilotinib and increased doses thereof. Results. 67.7% were male; average age was 50 years, 87% were in the chronic phase; 41.9% were high and intermediate risk and 10% of patients died. 31 patients were classified into 4 treatment groups: G1: imatinib / nilotinib, 67.7%; G2: nilotinib / imatinib, 3.2%; G3: imatinib / increased dose imatinib, 22.6%; and G4: nilotinib / increased dose nilotinib, 6.5%. McNemar test showed in patients refractoriness to the first line of treatment with Imatinib but improved its response with Nilotinib as the second line of treatment. Conclusions. Statistically significant differences were obtained demonstrating the effectiveness of nilotinib in patients with imatinib, preventing the progression of the disease, which was possible to verify with the quantification of the BCR / ABL1 gene, used to determine the treatment response.
Patients with chronic myeloid leukemia receive treatment with first-line targeted therapy, which are the first and second generation tyrosine kinase inhibitors, but may present refractoriness due to point mutations in the BCR / ABL1 gene. Objective. To determine the therapeutic response with tyrosine kinase inhibitors, in patients with refractory chronic myeloid leukemia, by quantification of the BCR / ABL1 gene in the Dr. Teodoro Maldonado Carbo hospital, period 2013 - 2017. Materials and methods. A correlational, non-experimental, cross-sectional study was performed, which included patients with chronic myeloid leukemia refractory to first-line treatment, and who received second-line treatment with imatinib or nilotinib and increased doses thereof. Results. 67.7% were male; average age was 50 years, 87% were in the chronic phase; 41.9% were high and intermediate risk and 10% of patients died. 31 patients were classified into 4 treatment groups: G1: imatinib / nilotinib, 67.7%; G2: nilotinib / imatinib, 3.2%; G3: imatinib / increased dose imatinib, 22.6%; and G4: nilotinib / increased dose nilotinib, 6.5%. McNemar test showed in patients refractoriness to the first line of treatment with Imatinib but improved its response with Nilotinib as the second line of treatment. Conclusions. Statistically significant differences were obtained demonstrating the effectiveness of nilotinib in patients with imatinib, preventing the progression of the disease, which was possible to verify with the quantification of the BCR / ABL1 gene, used to determine the treatment response.
Descripción
Palabras clave
Leucemia mieloide crónica, Biología molecular, PCR, Hospital de Especialidades Dr. Teodoro Maldonado Carbo, Cantón Guayaquil, Ecuador, Gen BCR/ABL1, Leucemia Mielógena Crónica BCR-ABL Positiva