回复给编辑的信

IF 5.2 3区 医学 Q1 NEUROSCIENCES Journal of Neuroimmune Pharmacology Pub Date : 2017-05-04 DOI:10.1080/10428194.2016.1233544
Qingsheng Li, Woong-Ki Kim
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引用次数: 0

摘要

我们感谢Sahu等人对我们的论文《妊娠:慢性粒细胞白血病生活的一部分》的评论[1] 他们提交的材料中强调的问题与资源有限、可能难以达到最佳护理标准的环境高度相关和重要。这种情况在发展中国家很常见,因为发展中国家获得药物的机会和通过先进分子诊断密切监测疾病的能力有限。在妊娠等不寻常的临床情况下治疗慢性粒细胞白血病(CML)需要一种个性化的方法,旨在优化护理,以确保尽可能为父母和胎儿带来有利的结果。如我们的论文所示,通过基于定量聚合酶链式反应(PCR)的检测来密切监测疾病状态,并明智地使用可用的治疗方法,可以有效地管理这些患者。尽管羟基脲和白细胞单采在某些情况下都是有用的辅助治疗药物,但几乎没有证据表明这些药物是所有病例的主要治疗方法。尽管新出现的数据描述了在妊娠早期接触伊马替尼和其他一些酪氨酸激酶抑制剂(TKIs)的患者胎儿的良好结果,但重要的是要考虑到,在检测到妊娠时立即停用这些药物,从而尽可能减少接触。[2-4]在未提前停用伊马替尼的情况下,记录了不良的胎儿结局。[5] 在这方面,基于干扰素的治疗似乎最不可能导致不良的母体或胎儿结局,并且除了单独的细胞减少外,还可以提供一些疾病控制措施。我们认识到,在资源受限的环境中,实践中可能存在差异,并认识到在管理复杂问题(如慢性粒细胞白血病患者的妊娠)方面可能存在的困难,特别是在年轻患者群体中。这种情况有效地证明了我们文章的前提,即CML患者的预期寿命现在与正常人的预期寿命几乎相同。必须努力确保怀孕和分娩也能成为一个可实现的里程碑,而不影响疾病控制。
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Reply to Letter to the Editor
We thank Sahu et al. for their comments on our paper ‘Pregnancy: part of life in chronic myelogenous leukemia.’[1] The issues highlighted in their submission are highly relevant and important to a setting where resources are constrained and optimal standards of care may be difficult to achieve. This situation is commonly encountered in developing countries where access to drugs and the ability to closely monitor disease by advanced molecular diagnostics is limited. Management of chronic myelogenous leukemia (CML) in unusual clinical situations such as pregnancy requires an individualized approach directed toward optimizing care to ensure favorable outcomes for both the parent and the fetus wherever possible. As shown in our paper, close monitoring of disease status by quantitative polymerase chain reaction (PCR)based testing and judicious use of available therapies can be used effectively to manage such patients. Although both the hydroxyurea and leukocyte apheresis are useful adjuncts to therapy in some conditions, there is little evidence to recommend these as the mainstay of management in all cases. Despite emerging data describing favorable outcomes in the fetuses of patients exposed to Imatinib and some other tyrosine kinase inhibitors (TKIs) in the early stages of pregnancy, it is important to consider that these agents were immediately withdrawn at the time pregnancy was detected thereby minimizing exposure where possible.[2–4] Adverse fetal outcomes were documented in cases where Imatinib was not discontinued early.[5] In this respect, interferon-based therapy appears to be the least likely to result in adverse maternal or fetal outcomes and can also provide some measure of disease control beyond cytoreduction alone. We recognize that there are likely to be differences in practice in resource-constrained settings and appreciate the difficulties that may be associated in managing complex issues such as pregnancy in CML, particularly in a younger patient population. This scenario effectively demonstrates the premise of our article that with the life expectancy of CML patients now being nearly the same as that of normal individuals. Efforts are necessary to ensure that pregnancy and childbirth can also be an achievable milestone without compromising disease control.
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来源期刊
CiteScore
13.60
自引率
0.00%
发文量
18
审稿时长
6-12 weeks
期刊介绍: The aims of the Journal of Neuroimmune Pharmacology are to promote the dissemination, interest, and exchange of new and important discoveries for the pharmacology and immunology of the nervous system. The aims parallel that of the Society on NeuroImmune Pharmacology by increasing the fundamental understanding of neurologic and neuropsychiatric disorders affected by the immune system or vice versa and towards pharmacologic measures that lead, either to a better understanding of disease mechanisms, or by improving disease outcomes. The scope of JNIP includes all primary works and reviews into the etiology, prevention, and treatment of neuroimmune and nervous system diseases affected by disordered immunity. Original studies serving to define neuroimmune modulation of environmental or endogenous cues such as toxins and drugs of abuse, hormones, and cytokines are welcome. JNIP will serve as a reliable source of interdisciplinary information bridging the fields of pharmacology, immunology, and neuroscience.
期刊最新文献
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