甲磺酸马替尼治疗慢性髓细胞白血病急性髓性变的疗效  

Efficacy of Imatinib Mesylate, a Specific Inhibitor of BCR/ABL Tyrosine Kinase, on Chronic Myeloid Leukemia in Blast Phase

作　　者：张国材[1] 郑冬[1] 李群华[2] 李小胡[3] 蔡成才[4] 罗绍凯[1] 李娟[1] 彭爱华[1] 童秀珍[1] 谭思勋[1] 洪文德[1] 

机构地区：[1]中山大学附属第一医院血液科,广东广州510080 [2]广东省人民医院血液科,广东广州510080 [3]江门市中心医院血液科,广东江门529000 [4]肇庆市第一人民医院血液科,广东肇庆526000

出　　处：《癌症》2004年第12期1696-1699,共4页Chinese Journal of Cancer

摘　　要：背景与目的:慢性髓细胞白血病急性髓性变后,治疗非常困难,预后极差。本文旨在探讨特异性BCR/ABL酪氨酸激酶抑制剂(甲磺酸马替尼,格列卫)治疗慢性髓细胞白血病急性髓性变的疗效。方法:甲磺酸马替尼治疗组19例与历史对照组22例均先用含阿糖胞苷的标准化疗方案诱导治疗2疗程后,治疗组用甲磺酸马替尼400mg/d继续巩固或诱导治疗,治疗4周如无效,则将剂量增加至600mg/d,继续治疗8周;如有效,则用该剂量继续维持,仍无效则停用。历史对照组则采用其他方案继续巩固或诱导治疗。结果:治疗组标准诱导治疗无效的16例患者用甲磺酸马替尼治疗,6例(38%)取得完全的血液学缓解,获大部分遗传学效应;2例(13%)获部分血液学缓解,1例(6%)回到慢性期,获小部分遗传学效应;总的血液学有效率为56%。存活1年者6例(38%)。对照组诱导治疗无效的18例患者采用其他方案诱导化疗,仅2例(11%)取得完全的血液学缓解;1例(6%)获部分血液学缓解,总有效率为17%;1年内存活者仅1例(6%)。两组比较,差异有显著性(P<0.05)。结论:甲磺酸马替尼治疗慢性髓细胞白血病急性髓性变疗效高、生存时间延长,且耐受性好。但仍存在复发和耐药问题。BACKGROUND &OBJECTIVE:Chronic myeloid leukemia (CML) in blast ph as e is refractory with a poor prognosis. This study was to evaluate efficacy of im atinib mesylate, a specific inhibitor of BCR/ABL tyrosine kinase, on CML in blas t phase. METHODS: Nineteen patients with CML in blast phase (imatinib treatment group) received induction of cytarabine-based standard chemotherapy for 2 cycle s, and 400 mg/d of imatinib mesylate for 4 weeks. Patients with no remission rec eived 600 mg/d of imatinib mesylate for another 8 weeks. Treatment of 600 mg/d o f imatinib mesylate was maintained if it showed effects after 8 weeks, otherwise it would be stopped.Twenty-two patients with CML in blast phase (historical co ntrol group) received inducement of cytarabine-based chemotherapy for 2 cycles, and other regimens of consolidation or continuous induction. RESULTS: Sixteen p atients of imatinib treatment group achieved no hematologic remission after indu ction. After treated with imatinib mesylate,6 of 16 (38%) achieved hematologic complete remission (CHR),and major cytogenetic response;2 of 16(13%) achieved h ematologic partial remission (PHR); 1 of 16 (6%) returned to chronic phase with minor cytogenetic response. Total hematologic response rate of imatinib treatme nt group was 57%; 1-year survival rate was 38%(6/16). Eighteen patients of hi storical control group achieved no hematologic remission after inducement. After treated with other regimens, 2 (11%) achieved CHR, and 1 (6%) achieved PHR. T otal hematologic response rate of historical control group was 17%; 1-year sur vival rate was 6%(1/18),significantly lower than that of imatinib treatment gro up(P< 0.05). CONCLUSIONS: Imatinib mesylate may have anti-leukemic activity, an d prolong survival time of patients with CML in blast phase. But problems of tum or relapse, and drug resistance are still present.

关 键 词：白血病 慢性髓性 急性变 甲磺酸马替尼 疗效 

分 类 号：R733.71[医药卫生—肿瘤]