López-Hernández MA, Banda-García L, Alvarado-Ibarra M

Idioma: Ingles.
Referencias bibliográficas: 41
Paginas: 164-173
Archivo PDF: 413.10 Kb.

RESUMEN

Antecedentes: el tratamiento de la leucemia mieloide crónica Ph+ ha cambiado rápidamente de la quimioterapia, en el siglo pasado, a la actual administración de inhibidores de la tirosina cinasa. Los resultados han mejorado en términos de supervivencia global.
Objetivo: analizar los resultados obtenidos con diferentes tipos de tratamiento en pacientes con leucemia mieloide crónica Ph+, atendi- dos en el Servicio de Hematología del Centro Médico Nacional 20 de Noviembre, ISSSTE, en la Ciudad de México.
Material y método: estudio observacional, longitudinal, retrospectivo, descriptivo y comparativo de pacientes atendidos de 1990 hasta 2010, con leucemia mieloide crónica Ph+ de novo, mayores de 15 años, de cualquier sexo. Se revisaron los expedientes clínicos. Los tratamientos se agruparon en quimioterapia, busulfán o hidroxiurea, interferón (IFN); trasplante de células progenitoras hematopoyéticas e inhibidores de la tirosina cinasa: imatinib, nilotinib o dasatinib.
Resultados: se incluyeron 206 pacientes que recibieron los siguientes tratamientos: quimioterapia (n = 66), interferón (n = 42), trasplante de células progenitoras hematopoyéticas (n = 35, de ellos, ocho fueron no mieloablativos) e inhibidores de la tirosina cinasa (n = 63). La mayor probabilidad de supervivencia global se alcanzó con inhibidores de la tirosina cinasa y trasplante de células progenitoras hematopoyéticas, 0.92 a 200 meses y 0.52 a 250 meses (p = 0.0001). La progresión a fase acelerada o blástica fue 4 y 2 (p = NS). La mortalidad fue de 9.5 y 48% (p = 0.001). La probabilidad de supervivencia con interferón o quimioterapia fue menor de 100 meses.
Conclusión: los inhibidores de la tirosina cinasa son la mejor opción terapéutica contra la leucemia mieloide crónica Ph+. Sin ser curativos, permiten largas supervivencias con toxicidad comúnmente aceptable. La segunda opción es el trasplante de células progenitoras hematopoyéticas que, aunque no es universalmente aplicable, es curativo, con el inconveniente de causar morbilidad y mortalidad altas. Estos resultados son similares a los reportados en otros centros

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