达沙替尼治疗伊马替尼耐药的慢性髓细胞白血病急变期临床分析  

Clinical effect of dasatinib in treatment of imatinib-resistant chronic myeloid leukemia blast crisis

作　　者：钟丽红[1,2] 杜新[1] 丘创华[1] 蔡云[1] 张巧霞[1] 楼瑾[1] 李明[1] 

机构地区：[1]深圳市第二人民医院,广东深圳518023 [2]广州医科大学,广州511436

出　　处：《临床血液学杂志》2016年第6期883-886,共4页Journal of Clinical Hematology

摘　　要：目的：评价达沙替尼治疗伊马替尼耐药的BCR-ABL阳性慢性髓细胞白血病急变期（CML-BC）的疗效和安全性。方法：对7例伊马替尼耐药的CML-BC患者,给予达沙替尼100 mg/d口服治疗,观察达沙替尼对CML患者的血液学、遗传学及分子生物学反应,并监测不良反应,评估疗效和耐受情况。结果：7例伊马替尼耐药的BCR-ABL阳性CML-BC患者服用达沙替尼治疗后均获得完全血液学缓解,4例达到完全细胞遗传学缓解,1例达到完全分子学反应。4例达沙替尼治疗后检测到突变,4例死亡。2例出现3-4级中性粒细胞减少和3-4级血小板减少。结论：达沙替尼治疗伊马替尼耐药的BCR-ABL阳性CML-BC患者起效迅速,可获得完全血液学及细胞遗传学缓解,甚至获得完全分子生物学缓解,但维持时间短,容易再次出现疾病进展。达沙替尼治疗后可出现新的ABL激酶区突变,导致患者对达沙替尼耐药。Objective： To evaluate the efficacy and safety of dasatinib in blastic-phase chronic myeloid leukemia（ CML） with resistance to imatinib. Method： Seven patients with imatinib-resistant CML received dasatinib 100 mg/d orally. We observed the hematologic,cytogenetic remission and molecular response and recorded the occurrence of side effects. The overall survival and tolerance were evaluated and monitored. Result： After the dasatinib treatment,all patients achieved complete hematologic response（ CHR）,4 cases achieved complete cytogenetic response（ CCyR）,1 case achieved complete molecular response（ CMR）. Mutation had been detected in 4 cases after dasatinib treatment,and 4 cases died. Three to four grade neutropenia and thrombocytopenia occurred on 2 patients. Conclusion： Dasatinib is an effective drug in imatinib-resistant BCR-ABL positive blastic-phase CML,and some patients could achieve CHR and CCyR,even CMR. But it could not maintain a long time,and disease progression will happen again. New mutations in ABL kinase domain are occurred in dasatinib treated patients wich leading to dasatinib-resistant.

关 键 词：达沙替尼 白血病 髓细胞 慢性 耐药 突变 

分 类 号：R733.72[医药卫生—肿瘤]