慢性骨髓性白血病之進步－治療及疾病監測

Advance of Chronic Myeloid Leukemia-Treatment and Disease Monitoring

卓士峯(Shih-Feng Cho) ； 劉大智(Ta-Chih Liu)

《內科學誌》 24卷5期 (2013/10) Pp. 399-407

https://doi.org/10.6314/JIMT.2013.24(5).05

摘要

慢性骨髓性白血病是骨髓造血幹細胞之基因突變，即費城染色體的產生，而此染色體會形成BCR-ABL融合基因，此融合基因本身會產生不正常活化之酪氨酸激酶，再活化下游產物，造成細胞不正常增生繁殖。有賴於治病機轉的了解，酪胺酸激酶抑制劑的發明造成治療上的大突破，於西元2000年起逐漸改變慢性骨髓性白血病治療模式，病人的預後得到顯著改善，隨著第二代酪胺酸激酶抑制劑之研發，治療的效果更上一層樓。除了治療上的突破，本疾病的監測也有十分重要的進展，尤其是分子檢驗方法的進步，大大提高了檢查的敏感度，可以在白血病細胞十分少時，仍然可以知道病情的動態變化，能及早進行治療策略的改變。

關鍵字

慢性骨髓性白血病 ； 費城染色體 ； 酪胺酸激酶抑制劑 ； 分子反應

並列摘要

Chronic myeloid leukemia is a hematopoietic stem cell disease, which is characterized by a reciprocal translocation between chromosomes 9 and 22, resulting in the formation of the Philadelphia chromosome. The product of this fusion gene, BCR-ABL, is associated with dereguled tyrosine kinase, and then proliferation of leukemic cells. The introduction of tyrosine kinase inhibitor revolutionized the treatment of chronic myeloid leukemia since 2000. The prognosis of patient has significant improvement compared with traditional treatment. The second generation tyrosine kinase inhibitor further improved the treatment result. With incorporation of molecular method such as polymerase chain reaction, monitoring of this disease also has important advance in recent years. High sensitivity of this molecular method makes disease monitoring possible when the leukemic cell was in very low level. When the disease has progression in molecular level, adjustment of treatment strategy can be done earlier to improve outcome.

並列關鍵字

Chronic myeloid leukemia ； Philadelphia chromosome ； Tyrosine kinase inhibitor ； Molecular response