伊马替尼治疗Ph染色体阳性慢性粒细胞白血病的临床观察

Efficacy and safety of Imatinib for Ph positive patients of chronic myeloid leukemia

目的:评价酪氨酸激酶抑制剂伊马替尼治疗Ph染色体阳性慢性粒细胞白血病的有效性及安全性。方法:90例慢性粒细胞白血病患者,其中慢性期67例,非慢性期23例(加速期14例,急变期9例),每天应用剂量分别为400,600mg。每周复查血常规,每3个月进行骨髓象及细胞遗传学检查,根据血象和骨髓象调整剂量。结果:观察截止时,84例(93.3%)获得血液学完全缓解;68例可评价遗传学效应,35例(51.5%)发生主要遗传学效应(慢性期30例,加速期3例,急变期2例),其中31例(88.6%)为遗传学完全缓解(慢性期27例,加速期2例,急变期2例)。11例(12.2%)患者发生严重白细胞和/或血小板减少,但可通过调整剂量控制。严重非血液学不良反应发生较少。结论:伊马替尼治疗Ph染色体阳性慢性粒细胞白血病患者疗效较好,可获得较高的完全血液学缓解率和主要细胞遗传学缓解率,起效迅速,且不良反应较少,可耐受或自行消失。

OBJECTIVE To evaluate the efficacy and safety of Imatinib （Gleevec） for patients with Ph positive chronic myeloid leukemia （CML）, METHODS A total of 90 CML patients （67 in chronic phase, 14 in accelerated phase and 9 in blast cri sis） were treated with 400 mg, 600 mg and 800 mg daily of oral Imatinib for 1 to 51 months respectively. All the patients underwent blood routine examination weekly and bone marrow puncture, cytogenetic examination every three months. Dose was adjusted according to the results of the above examinations. RESULTS 84（93. 3%）patients achieved complete hematological response. 68 patients could evaluate cytogenetic response. Imatinib induced major cytogenetic response in 35（51.5%） patients and complete cytogenetic response in 31 patients（88.6%）. Grade 3 or 4 neutropenia or thrombocytopenia occurred in 11 （12. 2%） patients, which were manageable or tolerated. Grade 3 or 4 nonhematologic adverse effects were infrequent. CONCLUSION Imatinib induced high rate of cytogenetic and hematologic responses in patients with Ph positive CML. The adverse effects were mild and manageable or no need for treatment.