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Original Article
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Korean J Med. 2015;88(4):406-419. Published online April 1, 2015.
DOI: https://doi.org/10.3904/kjm.2015.88.4.406
- 만성골수성백혈병 한국 치료 가이드라인-대한혈액학회
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김대영1, 이정옥2, 김경하3, 김병수4, 김성현5, 김여경6, 김형준6, 김인호7, 박선양7, 박준성8, 정주섭9, 정준원10, 정철원11, 조덕연12, 손상균13, 대한혈액학회 만성골수성백혈병연구회
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1울산대학교 의과대학 서울아산병원 혈액내과
2서울대학교 의과대학 분당서울대학교병원 혈액종양내과
3순천향대학교 의과대학 순천향대학교서울병원 종양혈액내과
4고려대학교 의과대학 고려대학교안암병원 종양혈액내과
5동아대학교 의과대학 동아대학교병원 혈액종양내과
6전남대학교 의과대학 화순전남대학교병원 혈액내과
7서울대학교 의과대학 서울대학교병원 내과
8아주대학교 의과대학 아주대학교의료원 종양혈액내과
9부산대학교 의학전문대학원 부산대학교병원 혈액종양내과
10연세대학교 의과대학 혈액내과학교실
11성균관대학교 의과대학 삼성서울병원 혈액종양내과
12충남대학교 의과대학 내과학교실
13경북대학교 의과대학 경북대학교병원 혈액종양내과
- Korean Guidelines for Treating Chronic Myelogenous Leukemia - The Korean Society of Hematology Chronic Myelogenous Leukemia Working Party
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Dae-Young Kim1, Jeong-Ok Lee2, Kyung-Ha Kim3, Byung Soo Kim4, Sung Hyun Kim5, Yeo-Kyeoung Kim6, Hyeoung-Joon Kim6, Inho Kim7, Seonyang Park7, Joon Seong Park8, Joo-Seop Chung9, June-Won Cheong10, Chul Won Jung11, Deog-Yeon Jo12, Sang Kyun Sohn13, Chronic Myelogenous Leukemia Working Party, the Korean Society of Hematology
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1Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
2Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
3Department of Oncology and Hematology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Korea
4Division of Oncology and Hematology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
5Division of Hematology and Oncology, Department of Internal Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
6Department of Hematology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, Korea
7Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
8Department of Hematology-Oncology, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Korea
9Department of Hemato-oncology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
10Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Korea
11Division of Hematology and Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
12Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
13Department of Hemato-Oncology, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
- Corresponding author: Sang Kyun Sohn ,Tel: +82-53-420-5587, Fax: +82-53-426-2046, Email: sksohn@knu.ac.kr
- Received: February 17, 2014; Revised: April 7, 2014 Accepted: May 5, 2014.
- 목적: 만성골수성백혈병의 진단 및 치료를 위한 한국 치료 가이드라인은 한국 실정에 맞춘 내용을 통해 국내 치료 방침 및 연구 기준을 표준화하기 위하여 제정되었다.
방법: 국내 만성골수성백혈병 전문가들을 대상으로 한 설문 조사와 자문 미팅을 거쳐 본 가이드라인을 작성하였다.
결과: 본 가이드라인에는 만성골수성백혈병의 진단 및 초기 검사, 예후인자, 만성기에서의 초치료 및 치료 중 확인 사항과 반응 평가, 이차 약제 변경 및 이후의 치료 반응 평가, 가속기 및 급성기에서의 치료와 반응 평가, 동종 조혈모세포 이식, 독성 평가 및 관리 등 만성골수성백혈병의 전반에 대한 국내 전문가들의 의견을 종합한 권고안을 제시하고 있다.
결론: 만성골수성백혈병의 치료는 최근 많은 발전이 있었으며 향후 예후 평가에 대한 연구 및 약제의 중단 가능성 평가 연구 등 다양한 연구들을 통해 더욱 더 많은 향상이 있을 것으로 기대된다.
߽ɾ :만성골수성백혈병, 티로신키나제억제제, 진단 및 치료 지침
- Abstract
- Background/Aims
The first edition of the Korean treatment guidelines for chronic myelogenous leukemia (CML) was published in 2006. We intend to update those guidelines to include the use of next-generation tyrosine kinase inhibitors (TKIs).
Methods
New guidelines were developed in 2012 based on the results of a survey and a consensus meeting of various Korean experts, the reports of recent clinical studies, and updated guidelines from external study groups.
Results
An assessment of risk factors is strongly recommended before treating newly diagnosed chronic phase CML. Imatinib, dasatinib, and nilotinib are reimbursable in Korea as first-line treatments, and the patient’s age, comorbidities, and possible adverse events should be considered in the choice of treatment. Molecular studies are recommended for assessing treatment efficacy instead of invasive cytogenetic response evaluations, and an early response is believed to correlate with a good prognosis. Second-line TKIs can be considered for patients who fail or are intolerant of first-line therapy, pending analysis of ABL tyrosine kinase mutation status. For treating advanced stages, a combination of TKIs with cytotoxic agents and hematopoietic cell transplantation is recommended. The adverse effects of TKI therapy can be managed via dose reduction and supportive care, or switching to an alternate TKI.
Conclusions
The use of TKIs has improved the outcome of CML treatment. Treatment-free remission after discontinuing TKIs might be possible in select patients who achieve sufficient response, indicating that curative treatment for CML can be expected in the future.
Keywords :Leukemia, chronic myelogenous, Protein-tyrosine kinases, Guideline
