Background: Renal adverse drug reactions (ADRs) associated with tyrosine kinase inhibitors (TKIs) in the treatment of chronic myeloid leukemia (CML) are relatively rare, and there is currently no standardized protocol for their management. Therefore, this study aimed to summarize renal ADRs related to TKIs use in CML and propose an evidence-based approach to monitor and manage these ADRs. Methods: A systematic literature review was performed to identify renal ADRs associated with TKIs in CML. Two authors screened the search results and extracted data from 37 eligible studies. These findings were then used to develop a scheme for clinicians to monitor and manage these ADRs. Results: Overall, imatinib seemed to be significantly linked to renal adverse events compared to other TKIs, and switching to dasatinib or nilotinib significantly improved renal function. Similar events were reported with bosutinib, although they were not statistically significant. However, most of the renal events reported on dasatinib were described as nephrotic syndrome that resolved with switching to imatinib. Few cases were reported with nilotinib that described tumor lysis syndrome (TLS)-related kidney injury. Conclusions: Recommendations include monitoring for progressive decline in the estimated glomerular filtration rate with imatinib, nephrotic syndrome with dasatinib, and TLS with nilotinib. Additionally, holding the offending TKI and managing renal ADRs according to local guidelines were adopted more frequently than reducing the TKI dose.
背景：在慢性粒细胞白血病（CML）治疗中，与酪氨酸激酶抑制剂（TKIs）相关的肾脏药物不良反应（ADRs）相对罕见，目前尚无标准化的管理方案。因此，本研究旨在总结与TKIs在CML治疗中相关的肾脏ADRs，并提出一种基于证据的监测和管理这些ADRs的方法。方法：通过系统文献回顾，识别与TKIs在CML治疗中相关的肾脏ADRs。两位作者筛选了检索结果，并从37项符合条件的研究中提取数据。这些发现被用于制定一套供临床医生监测和管理这些ADRs的方案。结果：总体而言，与其他TKIs相比，伊马替尼似乎与肾脏不良事件显著相关，而转换为达沙替尼或尼洛替尼可显著改善肾功能。博舒替尼也有类似事件的报道，尽管这些事件在统计学上不显著。然而，达沙替尼报道的大多数肾脏事件被描述为肾病综合征，通过转换为伊马替尼后得到缓解。尼洛替尼报道的少数病例描述了与肿瘤溶解综合征（TLS）相关的肾损伤。结论：建议包括监测伊马替尼相关的估计肾小球滤过率进行性下降、达沙替尼相关的肾病综合征以及尼洛替尼相关的TLS。此外，相较于减少TKI剂量，暂停使用相关TKI并根据当地指南管理肾脏ADRs更为常用。
肿瘤(癌症)患者之家