TKI治疗慢性髓系白血病的疗效及获得深层分子反应的相关影响因素分析

发布时间：2018-04-02 18:02

本文选题：慢性髓系白血病　切入点：酪氨酸激酶抑制剂　出处：《中国实验血液学杂志》2017年06期

【摘要】：目的:评价酪氨酸激酶抑制剂(TKI)治疗慢性髓系白血病(CML)的疗效,探讨获得深层分子反应(DMR)的影响因素。方法:对我院接受TKI治疗的131例成人CML患者的临床资料及随访结果进行了分析,评价各时间点治疗反应的疗效,分析影响获得MR~(4.5)的相关因素。结果:131例患者中位随访24(6-120)个月,其中30例在中位伊马替尼治疗12(1-69.6)个月换为尼洛替尼治疗,13例在中位伊马替尼治疗31.2(3.1-87.6)个月时换达沙替尼。治疗3、6及12个月的获得主要细胞遗传学反应(MCyR)率分别为78%、79.4%及95.9%,获得完全细胞遗传学反应(CCyR)率分别为48.8%、66.7%及73.5%。60%的患者3个月时BCR-ABL~(IS)10%,6个月BCR-ABL~(IS)1%占56.3%,12个月BCR-ABL~(IS)0.1%达55.2%。持续伊马替尼治疗组中53例(60.9%)获得MR~(4.5),31例(35.6%)能够获得稳定的MR~(4.5)。多因素分析显示,性别、诊断时WBC计数及3个月BCR-ABL~(IS)水平是获得MR~(4.5)的独立影响因素,3个月BCR-ABL~(IS)水平是获得稳定MR~(4.5)的独立影响因素。换第二代TKI组中18例(40.9%)获得MR~(4.5),3个月BCR-ABL~(IS)水平同样是获得MR~(4.5)的独立影响因素。结论:伊马替尼治疗新诊断CML患者获得细胞遗传学与分子学疗效优异,对于耐药或不能耐受患者换为第二代TKI同样能够获得满意的疗效且DMR率更高,获得早期分子反应预测MR~(4.5)和稳定的MR~(4.5)的累积发生率更高。
[Abstract]:Aim: to evaluate the efficacy of tyrosine kinase inhibitor (TKI) in the treatment of chronic myeloid leukemia (CML) and to explore the factors influencing the acquisition of deep molecular response (DMRs).Methods: the clinical data and follow-up results of 131 adult CML patients treated with TKI in our hospital were analyzed.Results A median follow-up of 246-120 months was performed in 131 patients, 30 of whom were treated with imatinib for 121-69.6) months and 13 patients were treated with nilotinib for 31.2n- 3.1-87.6 months, and dasatinib was replaced by dasatinib in the median imatinib treatment for 3.1-87.6 months.In the group of continuous imatinib treatment, 53 cases (60.9 cases) were treated with MRA (4.5 cases) and 35.6 cases (35.6 cases) were able to obtain stable MRA (4.5%).Multivariate analysis showed that sex, WBC count at diagnostic time and 3 months BCR-ABL level were independent influencing factors in obtaining MRR 4.5), and BCR-ABL WBC at 3 months were independent influencing factors for stable MRR 4.5).In the second generation TKI group (n = 18, n = 40.9), the level of BCR-ABL is also an independent factor.Conclusion: imatinib has excellent cytogenetic and molecular efficacy in the treatment of newly diagnosed CML. It can also obtain satisfactory curative effect and higher DMR rate in the second generation TKI for drug-resistant or intolerant patients.The cumulative incidence of early molecular reaction prediction of MRA 4.5) and stable MRA 4.5) was higher.
【作者单位】：解放军总医院血液科;
【分类号】：R733.72

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