低剂量化疗联合酪氨酸激酶抑制剂诱导治疗Ph染色体阳性急性淋巴细胞白血病的疗效和安全性  

The efficacy and safety of low-dose chemotherapy combined with tyrosine kinase inhibitors in the treatment of Philadelphia-chromosomal-positive acute lymphoblastic leukemia

作　　者：王欢[1,2] 赵婷 胡利娟[1] 李宗儒 江浩 秦亚溱[1] 赖悦云[1] 石红霞[1] 黄晓军[1] 江倩[1] Wang Huan;Zhao Ting;Hu Lijuan;Li Zongru;Jiang Hao;Qin Yazhen;Lai Yueyun;Shi Hongxia;Huang Xiaojun;Jiang Qian(Beijing University People’s Hospital,Peking University Institute of Hematology,National Clinical Research Center for Hematologic Disease,Beijing 100044,China;Beijing Chuiyangliu Hospital,Beijing 100021,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,北京100044 [2]北京市垂杨柳医院血液科,北京100021

出　　处：《中华血液学杂志》2022年第7期550-556,共7页Chinese Journal of Hematology

摘　　要：目的探讨低剂量化疗联合酪氨酸激酶抑制剂(TKI)作为Ph染色体阳性急性淋巴细胞白血病(Ph+ ALL)诱导治疗方案的有效性与安全性。方法回顾性分析2008年1月1日至2021年7月31日北京大学人民医院收治的217例初诊Ph+ ALL患者的临床资料, 通过logistics回归和Cox回归分析, 比较低剂量化疗与常规剂量化疗的疗效及不良反应。结果研究纳入217例患者, 中位年龄38(10~69)岁, 低剂量化疗组78例, 常规剂量化疗组139例。低剂量化疗组与常规剂量化疗组相比, 4周完全缓解(CR)率(98.7%对97.0%, P=0.766)及总CR率(100%对100%, P=1.000)差异均无统计学意义。多因素分析显示, 化疗剂量对无病生存率、总生存率无显著影响。而两组诱导化疗期间感染发生率(OR=0.444, 95%CI 0.227~0.866, P=0.017)、粒细胞缺乏持续时间(OR=0.272, 95%CI 0.128~0.576, P=0.001)、PLT<20×109/L持续时间(OR=0.487, 95%CI 0.232~1.022, P=0.057)及红细胞悬液输注量(OR=0.309, 95%CI 0.147~0.651, P=0.002)差异有统计学意义, 低剂量组均显著低或短于常规剂量化疗组。结论对于Ph+ ALL患者, 低剂量化疗联合TKI作为一线诱导治疗的疗效与常规剂量化疗相当, 且安全性好。Objective The study aims to explore the efficacy and safety of low-dose chemotherapy combined with tyrosine kinase inhibitor(TKI)as an induction therapy for Philadelphia-chromosomal-positive acute lymphoblastic leukemia(Ph+ALL).Methods The data of the consecutive newly diagnosed patients with Ph+ALL were reviewed.The efficacy and safety of low-dose chemotherapy and conventional-dose chemotherapy combined with TKI were compared.Results A total of 217 patients with a median age of 38(10-69)years old were included in this study.78 patients were in the low-dose chemotherapy group,and 139 patients were in the conventional-dose chemotherapy group.There were no significant differences in the 4-week complete remission(CR)rate(98.7%vs 97.0%,P=0.766)and overall CR rate(100%vs 100%,P=1.000)between the two groups.Multivariate analyses showed that the chemotherapy intensity was not related to the disease-free survival rate and overall survival rate.However,the lower incidence of infection(P=0.017),the shorter duration of neutropenia(P=0.001)and PLT<20×109/L(P=0.057),and the lower red blood cell transfusion volume(P=0.002)were more common in the low-dose chemotherapy group than in the conventional-dose chemotherapy group.Conclusions The low-dose chemotherapy is superior to the conventional-dose chemotherapy combined with TKI as induction therapy in Ph+ALL with similar efficacy but is safer.

关 键 词：白血病 淋巴细胞 急性 PH阳性 诱导治疗 酪氨酸激酶抑制剂 

分 类 号：R733.71[医药卫生—肿瘤]