国产达沙替尼治疗慢性髓系白血病急髓变伴Y253H突变1例报告

To observe the curative effect and security of the generic dasatinib for treatment of the chronic myeloid leukemia (CML) in blastic phase with Y253H gene mutation and to improve the understanding of the disease.We treated an elderly patient of CML in blastic phase with Y253H gene mutation with generic dasatinib (100 to 140 mg daily),the patient appeared to be resistant with imatinib mesylate and nilotinib after treatment.His blood regular reminded leukocytosis,peripheral blood basophils amounted to 71％,and there were different phase of immature cells in his peripheral blood,the results of bone marrow examination returned that the patient got Y253 H gene mutation positive,BCR-ABL fusion gene quantification was 2 496.11 copies/10 000 abl copies,and he had additional chromosome abnormality.We diagnosed the patient with CML in blastic phase by analyzing the results of his examination.Considering his age and tolerance,he was treated with domestic dasatinib.During the treatment analysis of blood,bone marrow,genetics and molecular examinations were taken regularly to evaluate the efficacy.Getting the information in details about the patient and learning pertinent literature to analyze this kind of disease.The patient's peripheral blood basophils descended to 5％ and immature cells disappeared in 1.5 months,getting complete hematologic response.His gene of Y253H turned to be negative,chromosomes were back to normal and BCR-ABL fusion gene quantification dropped to 21.04 copies/10 000 abl copies in 3 months,getting complete cytogenetic response and major molecular response.The patient's BCR-ABL fusion gene quantification dropped to 1.6 copies/10 000 abl copies in 8 months,getting the newly defined very deep molecular responses MR 4.0.During the treatment,there was no adverse event besides a transient pancytopenia.Patients of CML in blastic phase have a poor prognosis and some of them can get remission and live for a longer time by using TKI alone.Domestic dasatinib is effective and well tolerant for patients of CML in blastic phase with Y253H gene mutation.