初发慢性髓性白血病慢性期不同年龄患者临床特征、治疗和结局  

Clinical characteristics,treatment pattern,and outcomes in newly diagnosed patients with chronic myeloid leukemia in the chronic phase by age

作　　者：彭楠 窦雪琳 于露[1] 秦亚溱[1] 石红霞[1] 赖悦云[1] 侯悦[1] 黄晓军[1] 江倩[1] Peng Nan;Dou Xuelin;Yu Lu;Qin Yazhen;Shi Hongxia;Lai Yueyun;Hou Yue;Huang Xiaojun;Jiang Qian(Peking University People's Hospital,Peking University Institute of Hematology,National Clinical Research Center for Hematologic Disease,Beijing 100044,China)

机构地区：[1]北京大学人民医院,北京大学血液病研究所,国家血液系统疾病临床医学研究中心,100044

出　　处：《中华血液学杂志》2021年第2期101-108,共8页Chinese Journal of Hematology

基　　金：国家自然科学基金(81770161、81970140)。

摘　　要：目的探讨初发慢性髓性白血病慢性期(CML-CP)不同年龄患者的临床特征、治疗和结局。方法回顾性分析2006年1月至2019年12月在北京大学人民医院确诊的≥14岁初诊酪氨酸激酶抑制剂(TKI)一线治疗的CML-CP连续病例。结果共收集957例患者,男性597例(62.4%),中位年龄40(14~83)岁。按年龄分为<40岁组(470例,49.1%)、40~59岁组(371例,38.8%)和≥60岁组(116例,12.1%)。随年龄增长,初诊时脾大(P<0.001)、WBC≥100×10^(9)/L(P<0.001)、贫血(P<0.001)、PLT<450×10^(9)/L(P=0.022)、外周血原始细胞比例高(P=0.010)和具有Ph染色体附加异常(P=0.006)的患者比例降低,有合并症(P<0.001)、Sokal积分中/高危(P<0.001)和初始选择伊马替尼(P<0.001)的患者比例增高。而性别、ELTS危险度分布在各年龄组间差异无统计学意义(P值均>0.05)。多因素分析显示,≥60岁仅是影响患者总生存(OS)的不利因素(OR=3.7,95%CI 1.5~9.2,P=0.005),年龄与治疗反应和其他结局无显著相关性。TKI治疗中,随年龄增长,非血液学不良反应发生率显著增加(P<0.001),而血液学不良反应发生率相似。随访末期,随年龄增长,仍服用伊马替尼(P=0.026)和服用减量TKI(P<0.001)的患者比例显著增加。结论初发CML-CP不同年龄组患者的临床特征、TKI用药选择和剂量、治疗反应、OS期和非血液学不良反应发生率存在差异。Objective To explore the clinical characteristics,treatment patterns,and outcomes in newly diagnosed patients with chronic myeloid leukemia in the chronic phase(CML-CP)by age.Methods Clinical data of consecutive≥14 years old newly diagnosed CML-CP patients were retrospectively analyzed.Results This study included 957 patients.Of the patients,597(62.4%)were male.The median age was 40 years(range,14–83 years).The patients were stratified into three age groups:<40 years(n=470;49.1%),40–59 years(n=371;38.8%),and≥60 years(n=116;12.1%).The proportions of the patients who had splenomegaly(P<0.001),WBC≥100×10^(9)/L(P<0.001),anemia(P<0.001),PLT<450×10^(9)/L(P=0.022),more blasts in the blood(P=0.010),and clonal chromosome abnormalities in Philadelphia chromosome-positive cells(P=0.006)at diagnosis significantly decreased with age.However,the proportions of those with comorbidities(P<0.001),intermediate or high Sokal risk(P<0.001),and receiving imatinib as front-line therapy(P<0.001)significantly increased with age.No significant differences in gender and the EUTOS Long-Term Survival risks were noted across the three age groups.The multivariate analysis showed that≥60 years was an adverse predictor for overall survival.However,age was not significantly associated with tyrosine kinase inhibitor(TKI)therapy responses and other outcomes.The incidences of nonhematological toxicity were significantly increased with age during TKI therapy(P<0.001).However,those of hematological toxicity was similar across the three age groups.The proportions of the patients maintaining imatinib therapy(P=0.026)and receiving low-dose TKI therapy(P<0.001)significantly increased with age at the end of follow-up.Conclusions Significant differences exist in clinical characteristics,TKI response,overall survival rates,and nonhematological toxicity among newly diagnosed CML-CP patients of different ages.

关 键 词：白血病 髓性 慢性 年龄 酪氨酸激酶抑制剂 临床特征 治疗结局 

分 类 号：R733.72[医药卫生—肿瘤]