Clinical Analysis Of Second-line Treatment Of Chronic Myeloid Leukemia With Nilotinib And Dasatinib

Objective: To investigate and analyze the the efficacy and safety of the second generation tyrosine kinase inhibitors(dasatinib and nilotinib)for chronic myeloid leukemia patients in the course of treatment appeared resistant or intolerant.Methods: Observation the efficacy and safety of 78 cases received nilotinib,30 cases received dasatinib after imatinib failure or intolerance to switch 2nd TKI treatment in January 2015 to December 2020.All patients diagnosed with chronic myeloid leukemia chronic phase after the examination such as MICM in our hospital.Hematology response,Molecular response and cytogenetic response was assessedand at 3 months,6 months,12 month and the adverse.Results:1.The rates of major molecular response at 3 months were 54.6% for patients receiving nilotinib,53.3% for those receiving dasatinib.The rates of major molecular response at 6 months were 61.5% for patients receiving nilotinib,73.3% for those receiving dasatinib.The rates of major molecular response at 12 months were 78.9% for patients receiving nilotinib,63.6% for those receiving dasatinib.The rates of molecular response 4 at 3 months were37.9% for patients receiving nilotinib,20.0% for those receiving dasatinib.The rates of molecular response 4 at 6 months were 49.2% for patients receiving nilotinib,46.7% for those receiving dasatinib.The rates of molecular response 4 at 12 months were 66.2% for patients receiving nilotinib,45.4%for those receiving dasatinib.2.When nalotinib was replaced with dasatinib in the treatment of CML,the MMR rates was 42% at 3 months,50% at 6 months and 60% at 12 months.3.Comparison of the incidence of side effects between nilotinib and dasatinib: rash and fatigue occurred in 24(39.3%)and 21(34.4%)cases in the nilotinib group,respectively,and in the dasatinib group.In 1(4.5%)and 1(4.5%)cases,the nilotinib group was higher than the dasatinib group.Conclusions:1.In the chronic phase of CML,when imatinib is resistant or intolerant,switching to nilotinib or dasatinib has a good effect.2.For both imatinib and nilotinib resistance,switching to dasatinib can still obtain better curative effect.3.Second-line application of nilotinib and dasatinib have similar incidence and severity of adverse reactions,good safety,and tolerable.However,nilotinib has a higher rate of rash and fatigue.