Yeni Tanı Kronik Lenfositik Lösemi Hastasında Kovalent Btk İnhibitörü Kullanımı ve Tedavi Yönetimi
Özet
Kronik lenfositik lösemi (KLL) klinik seyri değişkenlik gösteren olgun B-hücre kökenli kronik lenfoproliferatif neoplazidir. Erken evre ve asemptomatik hastalarda aktif izlem temel yaklaşım olmakla birlikte, progresif lenfositoz, kısa lenfosit ikiye katlanma süresi, progresif lenfadenopati, semptomatik organomegali, gelişen sitopeniler veya hastalık ilişkili sistemik semptomların gelişmesi tedavi gereksinimini ortaya çıkarabilir. Hedefe yönelik tedavilerin kullanıma girmesiyle birlikte, Bruton tirozin kinaz (BTK) inhibitörleri KLL tedavisinde merkezi bir konuma yerleşmiştir. İkinci kuşak selektif ve kovalent bir BTK inhibitörü olan akalabrutinib, özellikle ileri yaşta ve eşlik eden hastalıkları bulunan bireylerde etkili ve yönetilebilir bir tedavi seçeneğidir. Bu bölümde, IGHV mutasyonsuz ve TP53 aberasyonu bulunmayan yeni tanı KLL hastasında akalabrutinib tedavisinin seçimi, tedavi sürecindeki hematolojik değişiklikler ve klinik yönetim yaklaşımı ele alınmıştır. Lenfosit ikiye katlanma süresinin altı aydan kısa olması nedeniyle tedavi endikasyonu gelişen hastada akalabrutinib başlanmış; tedavinin erken döneminde belirgin mutlak lenfosit artışı izlenmiştir. Ancak bu artış, lenfadenopatilerde gerileme ve klinik stabilitenin korunması nedeniyle hastalık progresyonu olarak değerlendirilmemiştir. Akalabrutinib tedavisinin kesintisiz sürdürülmesiyle yedinci aydan sonra mutlak lenfosit sayısında belirgin azalma gözlenmiş ve sekizinci aydan itibaren değerler 10 ×10⁹’nin L⁻¹ altında seyretmiştir. Bu olgu, BTK inhibitörü tedavisi sırasında görülebilen geçici lenfositozun doğru yorumlanmasının ve yalnızca periferik lenfosit sayısına dayanarak erken tedavi başarısızlığı kararı verilmemesinin klinik önemini göstermektedir.
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