110.3 🩺 內科專科考前版

110.3.0.1 📌 䞀頁重點

  • 22E:
    • Asciminib (Scemblix) STAMP allosteric: FDA 2021 R/R, expanded 2024 to 1st line (ASC4FIRST trial)
    • Olverembatinib for T315I (China + EU)
    • TFR (treatment-free remission): standard option for stable deep response
    • WHO 2022 classification update
  • Taiwan: 健保 imatinib (Gleevec, generic available); 健保 dasatinib (Sprycel) + nilotinib (Tasigna) + bosutinib + ponatinib 條件; 健保 asciminib 條件 (新); 健保 BCR-ABL PCR 充分

110.3.0.2 🌟 Pearls (8)

  1. ASC4FIRST (NEJM 2024): asciminib > imatinib MMR rate (68% vs 49%); now 1st line option
  2. TFR success ~ 50% even after stopping; need MR4/4.5 sustained ≥ 2 yr
  3. Ponatinib dose-reduction (OPTIC trial): 45 mg → 15 mg after MMR achieved → reduces CV risk
  4. DASISION trial: dasatinib > imatinib MMR (newer 2nd gen advantage)
  5. ENESTnd: nilotinib > imatinib similar advantage; CV concern
  6. Pregnancy + CML: imatinib teratogenic 1st trimester; consider IFN or TKI cessation; resume post-delivery
  7. Pediatric CML: imatinib + dasatinib approved; HSCT consideration
  8. Late-phase CML (BP): TKI + chemo (FLAG-IDA / hyper-CVAD per lineage) + HSCT mandatory if eligible

110.3.0.3 📍 Taiwan + 健保

  • 健保 imatinib (Gleevec, generic) — 充分
  • 健保 dasatinib (Sprycel) 條件
  • 健保 nilotinib (Tasigna) 條件
  • 健保 bosutinib (Bosulif) 條件
  • 健保 ponatinib (Iclusig) 條件 (T315I or 倚 lines)
  • 健保 asciminib (Scemblix) 條件 (新)
  • 健保 BCR-ABL qPCR (IS standardized) 充分
  • 健保 BCR-ABL kinase domain mutation Sanger 條件
  • 健保 HSCT for refractory / blast 條件
  • Olverembatinib 自費 / 郚分條件
  • 孞會: TSH (Taiwan Society of Hematology) + Taiwan CML Foundation

110.3.0.4 🎓 內專必懂 (8)

  1. CML pathogenesis BCR-ABL p210/p190
  2. TKI 5 代 + selection strategy
  3. Asciminib STAMP 1st line (22E)
  4. Response milestones (ELN/NCCN)
  5. TFR criteria + monitoring
  6. Kinase domain mutation analysis + T315I
  7. Pregnancy + CML management
  8. Blast phase + HSCT

⚠ AI 草皿。