达沙替尼治疗慢性粒细胞白血病进展期的疗效观察
发布时间：2019-06-29 20:37
【摘要】：目的观察第二代酪氨酸激酶抑制剂达沙替尼对16例慢性粒细胞白血病(CML)进展期患者的疗效,为判断疾病预后及调整治疗方案提供一定的依据。对象和方法选择2012年2月-2013年11月在安徽医科大学第一附属医院及安庆市立医院血液内科确诊的门诊或住院的CML进展期患者共16例,加速期3例,急变期13例,其中急淋变4例,急粒变5例,急单变4例。16例患者均口服达沙替尼治疗原发病,其中3例给予70mg每日2次口服,4例给予140mg每日1次,8例100mg每日1次(其中1例在服用四个月后仍未缓解,后调整为150mg每日1次),1例给予50mg每日2次,8个月后调整为140mg每日1次口服。观察患者服药后的临床疗效,评估患者血液学反应、遗传学反应以及不良反应情况,直到随访结束或疾病进展至死亡,计算生存时间。结果16例CML进展期患者中有9例(56.25%)获得CHR,其中达到缓解的中位时间为3个月,其中3例加速期患者有2例获得CHR,13例急变期患者有7例获得CHR;4例急淋变患者均获得CHR,1例在缓解两年后复发,1例在缓解18个月后进展为急髓变,2月后出现死亡,1例死于脐血移植;5例急粒变患者有3例获得CHR,4例急单变患者均未获得CHR。急变期患者的CHR及完全细胞遗传学缓解(CcyR)率较加速期无统计学差异(P=1.000),急变期患者疾病进展的发生率较加速期患者明显增加,但差异无统计学意义(P=0.136)。急变期患者3及3级以上血液学不良反应的发生率较加速期患者有所升高(P=0.518)。16例患者中有10例(62.5%)出现III-IV级血液学不良反应,短暂停药或者促造血治疗后血象有一定的恢复。非血液学不良反应中,16例患者有3例(18.75%)出现胸腔积液,其中2例并发心包积液;有6例(37.5%)患者在服药过程中出现发热,其中1例反复并发肺部感染;有4例(25.0%)患者出现胃肠道反应,所有患者在服药过程中均无肝功能损害及QTc间期延长。16例患者中有10例死亡,其余患者的随访时间为2~24个月。患者2年生存率是37.5%(6例/16例),中位生存时间是12个月(95%CI:0-24.9个月)。结论达沙替尼治疗CML进展期患者疗效较好,有较高的血液学及细胞遗传学缓解率,对于加速期、急淋变及急粒变的CML患者可作为优先的一个选择,但对于急单变的患者,单用达沙替尼疗效较差。由于疾病的异质性,疾病缓解的时间长短不一,待疾病恢复至慢性期时,可考虑尽早行异基因造血干细胞移植(Allo-HSCT),以期望获得更高的无进展生存期(PFS)。达沙替尼可以为那些有条件行Allo-HSCT的部分患者争取到时间和机会。
[Abstract]:Objective to observe the efficacy of dasatinib, a second generation tyrosine kinase inhibitor, in the treatment of 16 patients with chronic myeloid leukemia with advanced (CML), and to provide some basis for judging the prognosis of the disease and adjusting the treatment plan. Participants and methods A total of 16 patients with advanced CML diagnosed in the first affiliated Hospital of Anhui Medical University and Anqing Municipal Hospital from February 2012 to November 2013 were enrolled in this study. There were 3 patients in accelerated phase and 13 patients in acute stage, including 4 patients with acute lymphoid change, 5 patients with acute granulation and 4 patients with acute single change. All 16 patients were treated with dasatinib oral administration, of which 3 patients were given 70mg twice a day and 4 patients were given 140mg once a day. 8 cases of 100mg were treated once a day (1 case was not relieved after four months of administration, and then adjusted to 150mg once a day). One case was given 50mg twice a day and 8 months later adjusted to 140mg once a day. The clinical efficacy of the patients was observed, and the hematological reactions, genetic reactions and adverse reactions were evaluated until the end of follow-up or the progress of the disease to death, and the survival time was calculated. Results CHR, was obtained in 9 of 16 patients with advanced CML (56.25%). The median time to achieve remission was 3 months. Among them, 2 of 3 patients with accelerated CHR,13 and 7 of 7 patients with acute lymphoid disease had CHR,1 recurrence after two years of remission, 1 patient developed acute myelopathy after 18 months of remission, 1 died after 2 months of cord blood transplantation, and 1 patient died of cord blood transplantation after 2 months of remission, and 2 months after remission, 2 months later, 2 months after remission, 1 patient died of cord blood transplantation, 1 patient died of cord blood transplantation. CHR,4 was obtained in 3 of 5 patients with acute granulosis. CHR. was not obtained in 3 of 5 patients with acute granulosis. There was no significant difference in CHR and complete cytogenetic remission (CcyR) rate between patients with acute change and accelerated phase (P 鈮，
本文编号：2508095
[Abstract]:Objective to observe the efficacy of dasatinib, a second generation tyrosine kinase inhibitor, in the treatment of 16 patients with chronic myeloid leukemia with advanced (CML), and to provide some basis for judging the prognosis of the disease and adjusting the treatment plan. Participants and methods A total of 16 patients with advanced CML diagnosed in the first affiliated Hospital of Anhui Medical University and Anqing Municipal Hospital from February 2012 to November 2013 were enrolled in this study. There were 3 patients in accelerated phase and 13 patients in acute stage, including 4 patients with acute lymphoid change, 5 patients with acute granulation and 4 patients with acute single change. All 16 patients were treated with dasatinib oral administration, of which 3 patients were given 70mg twice a day and 4 patients were given 140mg once a day. 8 cases of 100mg were treated once a day (1 case was not relieved after four months of administration, and then adjusted to 150mg once a day). One case was given 50mg twice a day and 8 months later adjusted to 140mg once a day. The clinical efficacy of the patients was observed, and the hematological reactions, genetic reactions and adverse reactions were evaluated until the end of follow-up or the progress of the disease to death, and the survival time was calculated. Results CHR, was obtained in 9 of 16 patients with advanced CML (56.25%). The median time to achieve remission was 3 months. Among them, 2 of 3 patients with accelerated CHR,13 and 7 of 7 patients with acute lymphoid disease had CHR,1 recurrence after two years of remission, 1 patient developed acute myelopathy after 18 months of remission, 1 died after 2 months of cord blood transplantation, and 1 patient died of cord blood transplantation after 2 months of remission, and 2 months after remission, 2 months later, 2 months after remission, 1 patient died of cord blood transplantation, 1 patient died of cord blood transplantation. CHR,4 was obtained in 3 of 5 patients with acute granulosis. CHR. was not obtained in 3 of 5 patients with acute granulosis. There was no significant difference in CHR and complete cytogenetic remission (CcyR) rate between patients with acute change and accelerated phase (P 鈮，
本文编号：2508095
本文链接：https://www.wllwen.com/yixuelunwen/zlx/2508095.html
