第一代TKI治疗初治CML-CP合并vPh患者的疗效及遗传学特征  

Curative Efficacy of First Generation TKI in the Treatment of CML-CP Combined with vPh and Analysis of Its Genetic Characteristics

作　　者：谭琳[1] 谢瑜[1] 杨坚 刘琳[2] TAN Lin;XIE Yu;YANG Jian;LIU Lin(Department of Hematology,The First Affiliated Hospital of Kunming Medical University,Kunming 650032,Yunnan Province,China;Department of Hematology,The Second Affiliated Hospital of Kunming Medical University,Kunming 650101,Yunnan Province,China)

机构地区：[1]昆明医科大学第一附属医院血液科,云南昆明650032 [2]昆明医科大学第二附属医院血液科,云南昆明650101

出　　处：《中国实验血液学杂志》2020年第4期1162-1166,共5页Journal of Experimental Hematology

摘　　要：目的:探讨第一代酪氨酸激酶抑制剂(TKI)治疗初治慢性髓系白血病慢性期(CML-CP)合并Ph染色体变异易位(vPh)的疗效及遗传学特征。方法:选取昆明医科大学第一附属医院2010年1月到2017年5月收治的初治CML-CP合并vPh患者共60例,设为CML-CP-vPh组,以同期初治CML-CP合并典型Ph染色体患者107例设为对照组,2组均给予伊马替尼治疗。比较2组临床疗效、染色体核型特征及FISH信号类型特征,并采用Cox风险模型进行患者远期生存影响因素分析。结果:2组人口学和血液学基线资料比较差异无显著性(P>0.05);2组耐药发生率比较差异无显著性(P>0.05);但CML-CP-vPh组原发耐药和原发血液学耐药发生率均显著高于对照组(P<0.05)。2组累积CCyR率、累积MMR率、OS及EFS比较差异无显著性(P>0.05)。多因素Cox模型分析提示,vPh与CML-CP患者的OS和EFS并无相关性(P>0.05);CML-vPh患者OS影响因素为Sokal评分高危、外周血BBP比例≥10%、BCR-ABLIS治疗后3个月<10%、治疗后6个月达CCyR及治疗后12个月达MMR;EFS影响因素为BCR-ABLIS治疗后3个月<10%和治疗后12个月达MMR(P>0.05)。变异异位累及频率较高的区域包括12q1、12q2[9例(15.00%)]和1p3区[8例(13.33%)]。FISH信号类型中2G2R1Y型、1G1R2F型、1G2R1Y型、2G1R1Y型及1G1R1Y型占比分别为73.33%、10.00%、1.67%、1.67%、1.67%。结论:CML-CP合并vPh患者具有更高的对第一代TKI原发耐药率及原发血液学耐药率,而改用第二代TKI可改善患者长期生存,与合并典型Ph染色体者疗效接近。CML-CP合并v Ph患者并无特殊人口学和血液学特征,变异异位多累及12q1、12q2及1p3区域,而FISH信号类型则以2G2R1Y型最为常见。Objective:To investigate the curative efficacy of first generation TKI in the treatment of CML-CP combined with vPh and genetic characteristics.Methods:60 patients with CML-CP combined with vPh from January 2010 to May 2017 in the First Affiliated Hospital of Kunming Medical University were chosen as CML-CP-v Ph group,and 107 patients with CML-CP combined with typical Ph chromosome at the same time were chosen as control group.The patients in two groups were treated with imatinib;The curative efficacy,karyotype and FISH signal type were compared between 2 groups,and the factors influencing long-term survival of patients were analyzed by Cox risk model.Results:There was no significant difference in the demographic and hematological baseline data between 2 groups(P>0.05),and there was no significant difference in the incidence of drug-resistance between 2 groups(P>0.05).The incidence of primary drug-resistance and primary hematological drug-resistance in the CML-CP-vPh group were significantly higher than that in control group(P<0.05).There was no significant difference in the accumulative CCyR rate,accumulative MMR rate,OS and EFS between 2 groups(P>0.05).Multivariate Cox model analysis showed that vPh not correlated with OS and EFS of patients with CML-CP(P>0.05).The factors influencing OS in CML-vPh patients included high risk of Sokal scores,peripheral blood basophils proportion≥10%,BCR-ABLIS in 3 months after treatment<10%,achieviag CCyR in 6 months after treatment and achieviag MMR in 12 months after treatment(P<0.05).The factors influencing EFS included BCR-ABLIS<10%in 3 months after treatment and achieving MMR in 12 months after treatment(P<0.05).The regions with high frequency of heterotopic involvement included 12q1,12q2[9 cases(15.00%)]and 1p3[8 cases(13.33%)].The percentage of 2G2R1Y,1G1R2F,1G2R1Y,2G1R1Y and 1G1R1Y in FISH signal types were 73.33%,10.00%,1.67%,1.67%and 1.67%respectively.Conclusion:Patients with CML-CP combined with vPh possess higher primary drug-resistance rate and primary hematologi

关 键 词：酪氨酸激酶抑制剂 慢性髓性白血病慢性期 Ph染色体变异易位 疗效 遗传学特征 

分 类 号：R733.72[医药卫生—肿瘤]