Evaluación de la respuesta molecular como indicador pronóstico y terapéutico en pacientes con leucemia mieloide crónica
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2021
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
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ANTECEDENTES: La leucemia mieloide crónica es una neoplasia mieloproliferativa
que hasta la actualidad no se ha logrado remisión de la misma, pero la literatura mundial nos
indica que una evaluación de la respuesta molecular de manera oportuna, nos permite un
adecuado manejo terapéutico, y por ende, disminuir la morbi-mortalidad del paciente asociado
a la progresión de la enfermedad así como a mejorar su calidad de vida. OBJETIVO:
Determinar la tasa de respuesta molecular en pacientes con leucemia mieloide crónica que se
encuentran en tratamiento con inhibidores de tirosin kinasa (ITK). METODOLOGÍA: Se
realizó un estudio de tipo descriptiva, retrospectivo de corte transversal considerando a todos
los pacientes con diagnóstico de Leucemia mieloide crónica y se valoró la respuesta molecular
posterior a inicio de tratamiento con inhibidores de tirosin kinasa. RESULTADO: Se
estableció que al emplear el score SOKAL el 54.55% perteneció a grupo intermedio y alto,
por lo que estos pacientes tienen mayor probabilidad de morir. Que la respuesta molecular
mediante la prueba de homogeneidad marginal entre los momentos de seguimiento a los 3, 6 y
12 meses, evidenció diferencias significativas con p-valor <0,001 y el grupo de pacientes que
inició con NILOTINIB como primera línea vs IMATINIB, presentó el 100% respuesta
profunda observándose diferencias significativas con p-valor 0,018 a favor de Nilotinib.
BACKGROUND: Chronic myeloid leukemia is a myeloproliferative neoplasm that to date has not achieved remission, but the world literature indicates that an evaluation of the molecular response in a timely manner, allows us an adequate therapeutic management, and therefore, to reduce the morbidity and mortality of the patient associated with the progression of the disease as well as to improve their quality of life. OBJECTIVE: To determine the molecular response rate in patients with chronic myeloid leukemia who are under treatment with tyrosine kinase (TKI) inhibitors. METHODOLOGY: A descriptive, retrospective, cross sectional study was carried out considering all patients with a diagnosis of chronic myeloid leukemia and the molecular response after initiation of treatment with tyrosine kinase inhibitors was assessed. RESULT: It was established that when using the SOKAL score, 54.55% belonged to the intermediate and high group, which is why these patients are more likely to die. That the molecular response by means of the marginal homogeneity test between the follow-up times at 3, 6 and 12 months, showed significant differences with p-value <0.001 and the group of patients who started with NILOTINIB as first line vs IMATINIB, presented the 100% deep response, observing significant differences with p-value 0.018 in favor of Nilotinib. CONCLUSION: From the present study we can observe that every patient who does not show RMT (early molecular response) has a high risk of therapeutic failure.
BACKGROUND: Chronic myeloid leukemia is a myeloproliferative neoplasm that to date has not achieved remission, but the world literature indicates that an evaluation of the molecular response in a timely manner, allows us an adequate therapeutic management, and therefore, to reduce the morbidity and mortality of the patient associated with the progression of the disease as well as to improve their quality of life. OBJECTIVE: To determine the molecular response rate in patients with chronic myeloid leukemia who are under treatment with tyrosine kinase (TKI) inhibitors. METHODOLOGY: A descriptive, retrospective, cross sectional study was carried out considering all patients with a diagnosis of chronic myeloid leukemia and the molecular response after initiation of treatment with tyrosine kinase inhibitors was assessed. RESULT: It was established that when using the SOKAL score, 54.55% belonged to the intermediate and high group, which is why these patients are more likely to die. That the molecular response by means of the marginal homogeneity test between the follow-up times at 3, 6 and 12 months, showed significant differences with p-value <0.001 and the group of patients who started with NILOTINIB as first line vs IMATINIB, presented the 100% deep response, observing significant differences with p-value 0.018 in favor of Nilotinib. CONCLUSION: From the present study we can observe that every patient who does not show RMT (early molecular response) has a high risk of therapeutic failure.
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LEUCEMIA MIELOIDE DE FASE CRONICA, BIOLOGIA MELECULAR, EVALUACION, MANEJO TERAPEUTICO, EPIDEMIOLOGIA DESCRIPTIVA, ESTUDIOS RETROSPECTIVOS, HOSPITAL SOLCA DE GUAYAQUIL, CANTON GUAYAQUIL, ECUADOR