伊马替尼在慢性粒细胞性白血病慢性期治疗中的应用效果  

Clinical effect of imatinib on chronic myelogenous leukemia during chronic phase

作　　者：程雅馨 朱薇波[1] 刘欣[1] 蔡晓燕[1] 童娟[1] 姚雯[1] 张旭晗[1] 伍权[2] 

机构地区：[1]安徽医科大学附属省立医院安徽省立医院血液科,合肥230001 [2]安徽医科大学附属省立医院安徽省立医院中心实验室,合肥230001

出　　处：《中国临床保健杂志》2015年第6期607-611,F0003,共6页Chinese Journal of Clinical Healthcare

摘　　要：目的探讨伊马替尼治疗慢性粒细胞性白血病(CML)临床效果及生存情况,比较相关影响因素,为CML临床治疗提供依据。方法选取明确诊断为CML慢性期患者120名,监测各组行伊马替尼治疗后,获得完全血液学缓解(CHR)、完全细胞遗传学缓解(CCyR)、主要细胞遗传学缓解(MCyR)、完全分子学缓解(CMR)情况及不良反应。结果 3个月CHR为81%、6个月CCyR为57%、12个月主要分子学缓解(MMR)为33%,累积获得的CHR为97%,完全遗传学缓解为78%,CMR为40%,5年总生存期(OS)、5年无进展生存期(PFS)分别为89%和79%;Sokal评分系统5年PFS分别为96%、80%、69%(P=0.035,P=0.008),5年OS分别为100%、89%、71%(P=0.035,P=0.022)。EUTOS评分系统5年PFS分别为92%、71%(P=0.036,P=0.001),5年OS分别为94%、77%(P=0.026,P=0.005)低危组疗效均明显优于高危组,但Sokal评分低危组和中危组、中危组和高危组之间OS和PFS差异无统计学意义。对于患者在服用伊马替尼过程中,6个月细胞遗传学缓解率、12个月分子学缓解率与远期疾病进展密切相关(P<0.05)。根据单因素分析、COX回归分析,严重血细胞减少、停药>4周均为影响慢性期OS和PFS的不良因素,多因素分析中仅停药>4周为不良因素。非血液学不良反应未出现Ⅲ级以上不良反应,Ⅲ级以上血液学不良反应为粒细胞缺乏12%(16/120)、血小板减少7.5%(9/120),仅3例在治疗期间,反复出现Ⅲ级以上血细胞减少,改为尼洛替尼治疗。结论 (1)伊马替尼其良好的疗效及安全性适合多数新确诊的慢性粒细胞白血病慢性期患者,为慢性粒细胞白血病慢性期一线治疗药物;(2)对于伊马替尼治疗的疗效评价,EUTOS评分系统可能较Sokal评分系统更为有效;(3)对于处于Sokal高危组或EUTOS高危组的患者,应尽早使用二代酪氨酸激酶抑制剂提高临床缓解率。Objective To explore the clinical effect of imatinib on the chronic myeloid leukemia （CML） and compare the related factors,and provide the basis for clinical therapy of CML. Methods One hundred and twenty patients with chronic phase CML were selected, and were treated with imatinib, all data of complete hematological remission （ CHR）, complete cytogenetic remission （CCyR） , major cytogenetic response （MCyR） and complete molecular response （CMR） and adverse reactions were collected. Results The CHR of 3 months was 81%, the complete cytogenetic response （CCyR） of 6 months was 57% ,the major molecular remission （MMR） of 12 months was 33% ;the cumulative gain CHR was 97% ,the complete cytogenetic remission was 78% ,the complete molecular remission （CMR） was 40% and 5-year overall survival （OS） ,5 ,progression free survival （PFS） were 89% and 79% respectively; the Sokal scoring system of 5-year PFS were 96%, 80% and 69% （ P = 0. 035, P = 0. 008 ）, the 5 - year OS respectively were 100% ,89% ,71% （P = 0.035,P = 0. 022）. E UTOS scoring system for 5 years respectively were 92% ,71% （P = 0. 036 ,P = 0.001 ） ,5 years OS were 94% ,77% （P = 0. 026, P = 0. 005 ） ; Sokal score system,5 years PFS respectively were 96% ,80% ,69% （P=0.035,P =0.008） ,5 years OS were 100% ,89% ,71% （P =0.035,P =0.022）. Eutos prognostic scoring system of 5 -year PFS were 92% ,71% （P = 0.036, P = 0.001 ） and 5 -year OS were 94%, 77% （P = 0.026, P = 0. 005 ）. The effect of low risk group were significantly better than those in the high risk group, but there were no statistical significance by Sokal score. In the process of take imatinib, the cytogenetic remission rate of 6 months,the molecular remission rate of 12 months were closely related with the long - term disease progression （ P 〈 0. 05 ）. According to single factor analysis and COX regression analysis, severe blood cell reduction, stop drug 〉 4 weeks were the adverse factors of chronic phase OS and PFS, multiple fa

关 键 词：白血病 髓样 慢性期 甲磺酸盐类 缓解诱导 

分 类 号：R733.72[医药卫生—肿瘤]