二代酪氨酸激酶抑制剂一线二线治疗慢性髓细胞白血病的临床研究  

Clinical Study on Second-generation Tyrosine Kinase Inhibitors in the First-line and Second-line Treatment of Chronic Myeloid Leukemia

作　　者：陈亨[1] 蒋元强[1] 沈云峰[1] 陆米则[1] 王菱菱[1] 庄芸[1] 杨国华[1] 

机构地区：[1]江苏省无锡市人民医院血液科,江苏无锡214000

出　　处：《河北医学》2017年第10期1591-1594,共4页Hebei Medicine

基　　金：江苏省卫生厅资助基金项目;(编号:20130105)

摘　　要：目的:探讨二代络氨酸激酶抑制剂治疗慢性髓细胞白血病(CML)的临床疗效。方法:选择2013年1月至2016年12月收治的64例CML患者为研究对象,均接受二代络氨酸激酶抑制剂(TKI)治疗,其中尼洛替尼用药41例,达沙替尼用药23例;二代TKI中一线用药13例,二线用药51例,随访6~54个月,中位随访18个月;观察整体完全血液学缓解(CHR)率、CCyR率、主要细胞遗传学缓解(MCyR)率、MMR率及随访总生存率(OS)、无事件生存率(EFS);同时比较一线、二线治疗反应及药物不良反应情况。结果:随访截止时继续二代TKI治疗43例,死亡14例,停药2例,失访2例,更改用药方案3例;整体治疗反应:CHR率98.44%,MCyR率64.06%,CCyR率59.37%,MMR率43.75%;整体生存情况:患者OS、EFS均随病程延长而下降。一线治疗CCyR率、MCyR率、MMR率均明显高于二线治疗(P<0.05);尼洛替尼、达沙替尼用药不良反应发生率比较无显著差异(P>0.05)。结论:尼洛替尼、达沙替尼二代TKI治疗慢性髓细胞白血病疗效明确,预后良好,安全性较好;二代TKI一线治疗CML相比二线治疗效果更显著。Objective： To investigate the clinical effect of second-generation tyrosine kinase inhibitors in the treatment of chronic myeloid leukemia（ CML）. Methods： A total of 64 patients with CML treated between January 2013 and December 2016 were selected as study subjects and treated with second-generation tyrosine kinase inhibitor（ TKI）. Among them,there were 41 cases treated with Nilotinib and 23 cases with Dasatinib.In patients treated by TKI,there were 13 cases receiving first-line medication and 51 cases receiving secondline medication. All were followed up for 6 ~ 54 months,median 18 months. The overall complete hematologic remission（ CHR） rate,CCyR rate,rate of major cytogenetic response（ MCyR）,MMR rate,follow-up overall survival rate（ OS） and event free survival rate（ EFS） were observed; Meanwhile,the responses of firstline and second-line treatment and adverse drug reactions were compared. Results： At the end of follow-up,43 cases continued second-generation TKI treatment,14 cases died,2 cases stopped medication,2 cases were lost to follow up and 3 cases changed the medication regimen; In terms of overall responses to treatment,the rates of CHR,MCyR,CCyR and MMR were 98. 44%,64. 00%,59. 37% and 43. 75% respectively; In terms of overall survival status,OS and EFS decreased with duration of the disease. The rates of CCyR,MCyR and MMR of first-line treatment were significantly higher than the second-line treatment（ P 0.05）; There were no significant differences in the incidence of adverse drug reactions between Nilotinib and Dasatinib（ P 0.05）. Conclusion： The effect of Nilotinib and Dasatinib second-generation TKI in the treatment of CML is clear. The prognosis is good and safety is better; The effect of second generation TKI first-line treatment is better than second-line treatment in treating CML.

关 键 词：慢性髓细胞白血病 二代络氨酸激酶抑制剂 临床疗效 

分 类 号：R733.72[医药卫生—肿瘤]