演題詳細

一般口演 / Oral Session

一般口演 26 (Oral Session 26) :CML:臨床TKIその他

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日程
2013年10月11日(金)
時間
15:25 - 16:25
会場
第7会場 / Room No.7 (ロイトン札幌 2F リージェント)
座長・司会
鳥本 悦宏 (Yoshihiro Torimoto):1
1:旭川医科大学病院 腫瘍センター
 
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CMV colitis and chronic activated state in a CML patient during treatment with dasatinib

演題番号 : OS-1-133

林 邦雄 (Kunio Hayashi):1、加藤 るり (Ruri Kato):2、池本 純子 (Junko Ikemoto):2、池亀 和博 (Kazuhiro Ikegame):2、岡田 昌也 (Masaya Okada):2、西川 博嘉 (Hiroyoshi Nishikawa):3、小川 啓恭 (Hiroyasu Ogawa):2

1:Division of Hematology, Meiwa General Hospital、2:Department of Hematology, Hyogo College of Medicine、3:Experimental Immunology, Immunology Frontier Research Center, Osaka University

 

Introduction: TKIs have brought a precious clinical results of CML, however one of the residual problems of TKIs treatment is to overcome their intolerance such as CMV related complications. We study the case of a 54 y.o. man with CML who suffered from CMV colitis during dasatinib treatment and make clear of the immunological mechanism. Result: The patient was diagnosed with CML in December 2010. Treatment with imatinib was initiated at dose of 600mg/day, but it was discontinued within 3 weeks due to gastrointestinal complication and high fever. Then nilotinib was started at doses of 400mg/day as the second line, however gradually decreased to 2 times a week due to thrombocytopenia and anemia. Nilotinib could not bring molecular CR. In September 2011, dasatinib was started at dose of 120mg/day but this gave him high fever and myalgia. At that time, we replace the strategy of a single agent with the low dose combination of nilotinib and dasatinib. About 4 months later, he discharged blood and was diagnosed as CMV colitis that was cured after 20 days GCV treatment. Then dasatinib was reinitiated at a lower dose ( 50mg per every two days ). As the result of the examination of the viral reactivation and the cytotoxic T cells, dasatinib was proved to impair the proliferation and function of CMV-specific cytotoxic T lymphocytes. Conclusion: 1. Anergy against CMV with dasatinib was molecularly proved by the disappearance of CMV-specific T cells. 2. The lower dose combination of TKI agents is good policy to overcome intolerance including viral anergy.

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