While second generation tyrosine kinase inhibitors (2GTKIs) are highly effective therapies for chronic myeloid leukemia (CML), a significant minority of patients who initiate a 2GTKI will require a switch to an alternative TKI. The long-term outcomes of those who require a change in therapy after front-line 2GTKI therapy are largely undescribed. Here we describe the clinical outcomes associated with switch to an alternative TKI after first-line therapy with a 2GTKI. Of 232 patients who initiated a 2GTKI during the study period, 76 (33 %) switched to an alternative TKI. Reasons for switching included intolerance (79 %) and resistance (21 %). Among the 60 patients who switched due to intolerance, 53 (88 %) were able to achieve or maintain a major molecular response (MMR) with 5-year progression-free survival (PFS) 90.5 % (95 % CI 90.4–90.6 %). Amongst the 16 patients who switched due to resistance, 8 patients (50 %) were able to achieve MMR with 5-year PFS 80.4 % (95 % CI 80.2–80.6 %). Most patients who switched due to intolerance remained on their second-line TKI. Approximately 25 % of patients who initiate first-line 2GTKI in a real world setting will ultimately switch to an alternate TKI due to intolerance. Patients who switch for intolerance continue to enjoy excellent clinical outcomes.

虽然第二代酪氨酸激酶抑制剂 (2GTKI) 是治疗慢性髓性白血病 (CML) 的高效疗法，但极少数开始使用 2GTKI 的患者需要改用替代 TKI。在一线 2GTKI 治疗后需要改变治疗的患者的长期结果在很大程度上没有描述。在这里，我们描述了在使用 2GTKI 进行一线治疗后改用替代 TKI 的相关临床结果。在研究期间开始使用 2GTKI 的 232 名患者中，76 名 (33 %) 改用替代 TKI。转换的原因包括不耐受 (79%) 和抵抗 (21%)。在因不耐受而转换的 60 名患者中，53 名 (88 %) 能够达到或维持主要分子反应 (MMR)，5 年无进展生存 (PFS) 为 90.5 % (95 % CI 90.4–90.6 %) . 在 16 名因耐药而转换的患者中，8 名患者 (50%) 能够实现 MMR，5 年 PFS 为 80.4% (95% CI 80.2–80.6%)。大多数因不耐受而转换的患者仍使用二线 TKI。大约 25% 在现实世界环境中启动一线 2GTKI 的患者最终会由于不耐受而改用替代 TKI。转为不耐受的患者继续享有出色的临床结果。