Correlação entre adesão ao tratamento e resposta molecular, falha no tratamento e sobrevida global na leucemia mielóide crônica: uma revisão de literatura
Data
2024-08-26
Tipo
Trabalho de conclusão de curso
Título da Revista
ISSN da Revista
Título de Volume
Resumo
A Leucemia Mieloide Crônica (LMC) é uma neoplasia mieloproliferativa, provocada pela translocação entre os cromossomos 9 e 22, do qual origina-se o cromossomo Philadelphia (Ph). Essa doença hematológica apresenta três fases: crônica, acelerada (ou transformação) e crise blástica. Atualmente, a LMC é tratada por meio de medicamentos (inibidores de tirosina quinase, ITK) via oral, como: imatinibe, nilotinibe e dasatinibe, o qual exige do paciente a adesão a terapia. E em virtude da importância da adesão ao tratamento oral para essa neoplasia, este trabalho de revisão de literatura teve como objetivo: verificar se existe correlação entre a adesão e/ou a falta de adesão ao tratamento (com imatinibe e/ou nilotinibe e/ou dasatinibe) em pacientes adultos com Leucemia Mieloide Crônica (LMC) e os seguintes desfechos: sobrevida global e/ou resposta molecular e/ou falha no tratamento. Para isso, foi elaborada uma pergunta de pesquisa e montada uma estratégia de busca, a qual foi aplicada na base de dados PubMed, respeitando-se também critérios de exclusão estabelecidos para este estudo. Tal metodologia resultou na inclusão de 5 artigos para análise neste estudo de revisão, dos quais: a) todos possuem desenho observacional, com destaque para 3 trabalhos de coorte; b) o estudo com menor amostra contêm 38 pacientes e o com maior amostra possuí 300 pessoas; c) os ITK que mais apareceram nos estudos foram imatinibe e nilotinibe; d) os métodos mais empregados para verificar a adesão foram a Escala de Adesão à Medicação de Morisky (MMAS) e contagem de comprimidos; e) sobre os desfechos de interesse, o desfecho “sobrevida global” não foi encontrado em nenhum artigo incluído neste estudo, o desfecho “falha no tratamento” foi identificado em apenas um artigo, e a “Resposta Molecular” (RM) foi encontrada em todos os 5 artigos incluídos nesta revisão; e f) 3 estudos citam existir correlação entre adesão ao tratamento com ITK e o desfecho RM. Contudo, somente 1 desses 3 trabalhos apresentou medida de associação entre a adesão do paciente ao tratamento com os ITK e a RM. Portanto, com os resultados obtidos neste trabalho, foi possível verificar a existência de correlação entre a adesão ao tratamento com os ITK de interesse em pacientes adultos com LMC e o desfecho “Resposta Molecular”, evidenciando a importância da verificação da adesão ao tratamento oral com ITK, durante o acompanhamento de pacientes adultos com LMC e da Resposta Molecular.
Chronic Myeloid Leukemia (CML) is a myeloproliferative neoplasm caused by the translocation between chromosomes 9 and 22, from which the Philadelphia chromosome (Ph) originates. This hematologic disease has three phases: chronic, accelerated (or transformation), and blast crisis. Currently, CML is treated with oral medications (tyrosine kinase inhibitors, TKIs), such as imatinib, nilotinib, and dasatinib, which require patient adherence to therapy. And due to the importance of adherence to oral treatment for this neoplasm, this literature review aimed to verify whether there is a correlation between adherence and/or lack of adherence to treatment (with imatinib and/or nilotinib and/or dasatinib) in adult patients with Chronic Myeloid Leukemia (CML) and the following outcomes: overall survival and/or molecular response and/or treatment failure. To achieve this goal, a research question was developed, and a search strategy was created, which was applied to the PubMed database, also respecting the exclusion criteria established for this study. This methodology resulted in the inclusion of 5 articles for analysis in this review study, of which: a) all had an observational design, with emphasis on 3 cohort studies; b) the study with the smallest sample contained 38 patients and the one with the largest sample had 300 individuals; c) the TKIs that appeared most in the studies were imatinib and nilotinib; d) the methods most used to verify adherence were the Morisky Medication Adherence Scale (MMAS) and pill count; e) regarding the outcomes of interest, the outcome “overall survival” was not found in any article included in this study, the outcome “treatment failure” was identified in only one article, and the “Molecular Response” (MR) was found in all 5 articles included in this review; and f) 3 studies mention a correlation between adherence to TKI treatment and the MR outcome. However, only 1 of these 3 studies presented a measure of association between patient adherence to treatment with TKI and MR. Therefore, with the results obtained in this study, it was possible to verify the existence of a correlation between adherence to treatment with the TKI of interest in adult patients with CML and the outcome “Molecular Response”, highlighting the importance of verifying adherence to oral treatment with TKI during the follow-up of adult patients with CML and the Molecular Response.
Chronic Myeloid Leukemia (CML) is a myeloproliferative neoplasm caused by the translocation between chromosomes 9 and 22, from which the Philadelphia chromosome (Ph) originates. This hematologic disease has three phases: chronic, accelerated (or transformation), and blast crisis. Currently, CML is treated with oral medications (tyrosine kinase inhibitors, TKIs), such as imatinib, nilotinib, and dasatinib, which require patient adherence to therapy. And due to the importance of adherence to oral treatment for this neoplasm, this literature review aimed to verify whether there is a correlation between adherence and/or lack of adherence to treatment (with imatinib and/or nilotinib and/or dasatinib) in adult patients with Chronic Myeloid Leukemia (CML) and the following outcomes: overall survival and/or molecular response and/or treatment failure. To achieve this goal, a research question was developed, and a search strategy was created, which was applied to the PubMed database, also respecting the exclusion criteria established for this study. This methodology resulted in the inclusion of 5 articles for analysis in this review study, of which: a) all had an observational design, with emphasis on 3 cohort studies; b) the study with the smallest sample contained 38 patients and the one with the largest sample had 300 individuals; c) the TKIs that appeared most in the studies were imatinib and nilotinib; d) the methods most used to verify adherence were the Morisky Medication Adherence Scale (MMAS) and pill count; e) regarding the outcomes of interest, the outcome “overall survival” was not found in any article included in this study, the outcome “treatment failure” was identified in only one article, and the “Molecular Response” (MR) was found in all 5 articles included in this review; and f) 3 studies mention a correlation between adherence to TKI treatment and the MR outcome. However, only 1 of these 3 studies presented a measure of association between patient adherence to treatment with TKI and MR. Therefore, with the results obtained in this study, it was possible to verify the existence of a correlation between adherence to treatment with the TKI of interest in adult patients with CML and the outcome “Molecular Response”, highlighting the importance of verifying adherence to oral treatment with TKI during the follow-up of adult patients with CML and the Molecular Response.