单中心74例慢性髓系白血病一线伊马替尼治疗中IMTF预测模型的价值  

Value of IMTF prediction model in 74 patients with chronic myelogenous leukemia treated with first-line imatinib in a single center

作　　者：段晓晖 高山 王健红 董红娟 冯娟 唐海龙 吕垚 王世雄 吴振天 张涛 高广勋 梁蓉 DUAN Xiaohui;GAO Shan;WANG Jianhong;DONG Hongjuan;FENG Juan;TANG Hailong;LYU Yao;WANG Shixiong;WU Zhentian;ZHANG Tao;GAO Guangxun;LIANG Rong(Department of Hematology,the First Affiliated Hospital of Air Force Medical University,Shaanxi Xi'an 710032,China)

机构地区：[1]空军军医大学第一附属医院血液内科,陕西西安710032

出　　处：《现代肿瘤医学》2023年第10期1880-1886,共7页Journal of Modern Oncology

基　　金：国家自然科学基金(编号:8136064);西京医院学科助推计划项目(编号:XJZT18ML81,XJZT18MDT20,XJZT19Z28,XJZT18ML80,XJZT21CZ07);研究生创新实践能力提升项目(编号:ZG023)。

摘　　要：目的:探讨伊马替尼治疗失败(imatinib-therapy failure, IMTF)预测模型在不同预后分层患者的完全细胞遗传学反应(complete cytogenetic response, CCyR)、主要分子反应(major molecular response, MMR)、分子反应4.0(molecular response 4.0,MR4.0)、分子反应4.5(molecular response 4.5,MR4.5)、无治疗失败生存(failure-free survival, FFS)中的预测价值,分析早期是否获得最佳疗效对远期持续深层分子反应(deep molecular response, DMR)的意义。方法:收集我中心2018年至2021年确诊185例Ph阳性慢性髓系白血病(chronic myelogenous leukemia, CML)患者的临床资料,随访并进行预后分析。结果:185例患者中,74例患者进行规律治疗并定期监测,中位发病年龄为45.5(11~78)岁,男性占68.9%(51/74),脾大患者占64.9%(48/74);Sokal评分下低危45例(60.8%)、中危26例(35.1%)、高危3例(4.1%),低中危组患者FFS明显优于高危组的患者;ELTS评分下低危15例(20.3%)、中危31例(41.9%)、高危28例(37.8%),不同预后分层患者的CCyR、MMR、MR4.0及MR4.5、FFS均无统计学差异;IMTF积分下极低危4例(5.4%)、低危10例(13.5%)、中危23例(31.1%)、高危26例(35.1%)、极高危11例(14.9%),在FFS方面,极高危组的患者预后差;3个月时融合基因<10%占59.4%(41/69),3个月时早期达到最佳疗效与未达到最佳疗效的患者相比,2年及5年DMR均有显著差异,6个月及12个月是否达到最佳疗效对2年及5年DMR没有影响。结论:IMTF模型与传统的积分相比,可以更加精准地筛选出潜在极高危的患者,并更好地预测FFS,进一步区分出可能出现伊马替尼失败的这部分患者,指导TKI药物的选择,有助于远期持续DMR。Objective:To investigate the predictive value of imatinib-therapy failure(IMTF)prediction model in complete cytogenetic response(CCyR),major molecular response(MMR),molecular response 4.0(MR4.0),molecular response 4.5(MR4.5)and failure-free survival(FFS)of patients with different prognostic stratifications,and to analyse the significance of early optimal response on long-term sustained deep molecular response(DMR).Methods:Clinical and follow-up data were collected for analyzing the prognosis in 185 patients with Ph-positive chronic myelogenous leukemia(CML)in our centre from 2018 to 2021.Results:Among the 185 patients,74 patients received regular treatment and regular monitoring.The median age of onset was 45.5(11~78)years old.68.9%(51/74)patients were males.64.9%(48/74)patients had splenomegaly.According to the Sokal score,there were 45(60.8%)patients in low risk,while there were 26(35.1%)patients in intermediate risk,and 3(4.1%)patients in high risk.FFS of patients in low and intermediate risk group was significantly better than those in high risk group.According to the ELTS score,there were 15(20.3%)patients in low risk,while there were 31(41.9%)patients in intermediate risk,and 28 (37.8%) patients in high risk.CCyR,MMR,MR4.0,MR4.5,FFS were not statistically significant in patients with different prognostic stratifications.According to the IMTF score,there were 4 (5.4%) patients in very low risk,10 (13.5%) patients in low risk,23 (31.1%) patients in intermediate risk,26 (35.1%) patients in high risk,and 11 (14.9%) patients in very high risk.In FFS,the prognosis of patients in the very high risk group was poor.59.4% (41/69) patients had fusion gene <10% at 3 months.There was a significant difference in DMR at 2 and 5 years between patients who achieved an early optimal response at 3 months and those who did not.There was no difference in DMR at 2 and 5 years between patients who achieved an optimal response at 6 and 12 months and those who did not. Conclusion: Compared with the traditional score,the IMTF model

关 键 词：IMTF 慢性髓系白血病 伊马替尼 预测价值 

分 类 号：R733.72[医药卫生—肿瘤]