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Desafiando límites: innovación y evolución en el tratamiento de la Leucemia Mieloide Crónica (LMC)
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La leucemia mieloide crónica (LMC) es un tipo de cáncer de la sangre que afecta a las células en la médula ósea, representa aproximadamente el 15% de todos los casos de leucemia1,2,3. Se caracteriza por una producción excesiva de los glóbulos blancos. A menudo su desarrollo es lento, y gracias a los avances en el tratamiento desde hace dos décadas, los pacientes logran alcanzar una expectativa de vida similar a la población general4,5.
En 2017, se reportaron 34.179 nuevos casos de LMC y 24.054 muertes relacionadas con la enfermedad a nivel mundial 7. Aunque se observó una disminución en las tendencias de incidencia entre 1990 y 2017, la carga relacionada con la salud de la LMC sigue siendo un desafío significativo para las regiones con un bajo índice sociodemográfico7, 9.
Este tipo de cáncer hematológico afecta principalmente a los adultos y, rara vez, a niños y adolescentes1,4. Se origina en las células mieloides que se encuentran en la médula ósea, y se debe a un intercambio anormal de información entre el cromosoma 9 y el cromosoma 228. Este fenómeno conocido como translocación, da lugar al llamado cromosoma Filadelfia, que causa la producción anormal de la proteína BCR::ABL, permitiendo el crecimiento descontrolado de las células4,8. Este cromosoma Filadelfia se identifica en el 95% de los casos de LMC2,8.
Síntomas y diagnóstico de la LMC
Uno de los desafíos en su detección es la inespecificidad de los síntomas, puesto que muchos de estos pueden presentarse también en otros tipos de cáncer o incluso en condiciones no relacionadas10. Entre los más comunes se encuentran: debilidad, fatiga, fiebre, sudores nocturnos, pérdida de peso sin causa aparente, dolor en los huesos y agrandamiento del bazo, que se manifiesta como una sensación de llenura o dolor en el lado izquierdo del abdomen10,12.
Entre algunos factores de riesgo para desarrollar LMC están: edad avanzada; ser hombre, ya que el diagnóstico es ligeramente mayor en ellos que en mujeres; y la exposición previa a radiación, como la asociada al tratamiento de ciertos tipos de cáncer2,3.
Su diagnóstico suele ocurrir durante revisiones de rutina o cuando se realizan pruebas de sangre debido a algún otro síntoma12. Los exámenes que se solicitan son: un cuadro hemático para evaluar el número de células en la sangre; una biopsia de médula ósea que permite observar células cancerosas; y estudios genéticos como la prueba de reacción en cadena de la polimerasa (PCR) para detectar el cromosoma Filadelfia2,12.
Tratamientos disponibles para la LMC
Su tratamiento ha evolucionado significativamente en los últimos años, ya que hasta la década de los 2000, los pacientes eran tratados con interferón, lo cual muchas veces no lograba resultados duraderos, requiriendo un trasplante de médula ósea8,13. La introducción de los denominados inhibidores de la tirosina quinasa (ITKs) cambió radicalmente el panorama para estos pacientes13,15.
Los ITKs actúan bloqueando la acción de la proteína BCR::ABL1, reflejado en la detención del crecimiento de las células leucémicas13,14. Han alcanzado hitos importantes en el manejo de la LMC, como es una expectativa de vida similar a la de la población general, consiguiendo una remisión de la enfermedad por tiempos prolongados15.
Nuevos tratamientos y avances en investigación
De todas formas, aún hoy en día un número importante de pacientes desarrollan resistencia o intolerancia a estos ITK y, por más que se acuda al uso de todos estos, se evidencia la necesidad de seguir investigando e innovando en este campo15,16. Un área prometedora es la investigación de nuevas moléculas dirigidas a otros blancos terapéuticos, brindando una alta eficacia, menor toxicidad y efectos secundarios17. Estos aspectos críticos, en términos de calidad de vida, siguen rompiendo barreras en la LMC a través de la innovación como motor de evolución17.
En La Voz de Consultorsalud conversamos con la Dra. Claudia Agudelo, médica especialista y miembro de la Asociación Colombiana de Hematología y Oncología, para analizar el impacto de las enfermedades hematológicas crónicas, con un enfoque especial en la leucemia mieloide crónica, escúchalo aquí.
Referencias:
- 1 American Cancer Society. (S.F). ¿Qué causa la leucemia mieloide crónica? https://www.cancer.org/es/cancer/tipos/leucemia-mieloide-cronica/causas-riesgos-prevencion/que-lo-causa.html
- 2 Mayo Clinic. (S.F). Leucemia Mieloide Crónica. https://www.mayoclinic.org/es/diseases-conditions/chronic-myelogenous-leukemia/symptoms-causes/syc-20352417
- 3 American Cancer Society. (S.F). Leucemia. Recuperado de: https://www.cancer.org/es/cancer/tipos/leucemia.html
- 4 American Cancer Society. (S.F). Leucemia Mieloide Crónica. https://www.cancer.org/es/cancer/tipos/leucemia-mieloide-cronica/acerca.html
- 5 American Cancer Society. (S.F). ¿Qué causa la leucemia mieloide crónica? https://www.cancer.org/es/cancer/tipos/leucemia-mieloide-cronica/causas-riesgos-prevencion/que-lo-causa.html
- 6 Mayo Clinic. (S.F). Leucemia Mieloide Crónica. https://www.mayoclinic.org/es/diseases-conditions/chronic-myelogenous-leukemia/symptoms-causes/syc-20352417
- 7 .Lin Q, Mao L, Shao L, Zhu L, Han Q, Zhu H, Jin J, You L. Global, Regional, and National Burden of Chronic Myeloid Leukemia, 1990-2017: A Systematic Analysis for the Global Burden of Disease Study 2017. Front Oncol [Internet]. 2020 [consultado en diciembre de 2023];10. Disponible en: https://www.frontiersin.org/journals/oncology/articles/ 10.3389/fonc.2020.580759/full
- 8 NIH. (S.F). Tratamiento de la leucemia mielógena crónica. https://www.cancer.gov/espanol/tipos/leucemia/paciente/tratamiento-lmc-pdq
- 9 Lin, Q., Mao, L., Shao, L., Zhu, L., Han, Q., Zhu, H., Jin, J., & You, L. (2020). Global, Regional, and National Burden of Chronic Myeloid Leukemia, 1990-2017: A Systematic Analysis for the Global Burden of Disease Study 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7770240/
- 10 American Cancer Society. Signos y síntomas de la leucemia mieloide crónica. https://www.cancer.org/es/cancer/tipos/leucemia-mieloide-cronica/deteccion-diagnostico- clasificacion-por-etapas/senales-sintomas.html 11 Mayo Clinic. (S.F). Leucemia Mieloide Crónica. https://www.mayoclinic.org/es/diseases-conditions/chronic-myelogenous-leukemia/symptoms-causes/syc-20352417
- 12 American Cancer Society. (S.F). Pruebas para diagnosticar la leucemia mieloide crónica. https://www.cancer.org/es/cancer/tipos/leucemia-mieloide-cronica/deteccion-diagnostico-clasificacion-por-etapas/como-se-diagnostica.html
- 13 Leukremia Lymphoma Society. Remisión sin tratamiento en pacientes
- 14 Novartis. ¿Qué es la LMC?. https://www.profesionalessanitarios.novartis.es/hematohub/leucemia-mieloide-cronica/sobre-lmc/que-es/#dwell
- 15 Hughes, T. P., Saglio, G., Geissler, J., Kim, D. W., Lomaia, E., Mayer, J., … & Cortes, J. (2023). Asciminib (ASC) Add-on to Imatinib (IMA) Demonstrates Sustained High Rates of Ongoing Therapy and Deep Molecular Responses (DMRs) with Prolonged Follow-up in the ASC4MORE Study. https://ashpublications.org/blood/article/142/Supplement%201/866/502443/Asciminib-ASC-Add-on-to-Imatinib-IMA-Demonstrates
- 16 Cancer Research UK. Daily life and chronic myeloid leukaemia (CML). https://www.cancerresearchuk.org/about-cancer/chronic-myeloid-leukaemia-cml/living-with/daily-life
- 17 Tan, B. K., Bee, P. C., Chua, S. S., & Chen, L. C. (2021). Monitoring and improving adherence to tyrosine kinase inhibitors in patients with chronic myeloid leukemia: a systematic review. Recueperado de: https://www.tandfonline.com/doi/full/10.2147/PPA.S269355
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