格列卫治疗慢性粒细胞白血病急变期患者的临床疗效及毒性反应观察

Observation on the effect and toxicity of imatinib mesylat for patients with chronic myelogenous leukemia in blast crisis (CML-BC)

目的评价格列卫治疗慢性粒细胞白血病急变期患者的疗效及毒性反应。方法36例患者中31例患者单用格列卫治疗,有5例加用亚砷酸治疗,根据患者耐受情况调整格列卫剂量。开始每2天复查外周血涂片、血常规,每周复查肝肾功能,1个月后每周复查外周血涂片、血常规,每2周复查肝肾功能,每1个月进行骨髓细胞形态学检查,每3个月进行细胞遗传学检查,记录治疗过程中的不良反应。结果1个月时血液学缓解率(包括CHRT和NEL)66.7%,服用格列卫3个月后进行细胞遗传学检查,5例附加染色体异常消失,其中部分细胞遗传学缓解3例,完全细胞遗传学缓解2例。血液学不良反应以白细胞、血小板减少多见,非血液学不良反应以恶心、呕吐、水肿多见,其次为骨骼肌酸痛、乏力、头昏常见,而胸腔积液、头痛、皮疹等少见。结论尽管格列卫是一种较安全的药物,其治疗慢粒急变期患者近期疗效明显,但远期疗效并不理想。

Objective To evaluate the effcct and toxicity of imatinib mesylat for patients with chronic myelogenous leukemia in blast crisis （CML-BC）. Methods 31 patients in the 36 patients accept treatment which only includes imatinib mesylate,and 5 patients accept treatment which only includes imatinib mesylate and arsenious acid. Ajust the dose of Arsenious acid accordin to patient tolerance.At the beginning,examined the peripheral blood smear and blood routine every two days and examined hepatic and renal function every week. After 1 month,examined the peripheral blood smear and blood routine every week and examined hepatic and renal function every two weeks. Examined the morphology of medullary cells every month and examine cytogenetic every three months,and recorded the adverse reaction during theropy. Results After 1 month,hematology remission rate was（including CHR and NEL）66.7%. After 3 months,obnormal chromosome diappear in 5 patients,including 3 patients who achieve partial cytogenetic response and 2 patients who achieve complete cytogenetic response. Hematologic adverse reaction mainly includes eucopenia and thrombocytopenia.The main performance of the non-hematology toxicity was feel vomitive,disgusting and edema. Secondly,skeletal muscle aching,hypodynamia and dizziness was common. Pleural effusion、headache and rash was rare. Conclusion Although imatinib mesylat is a kind of safe drug,curative effect is obvious for the paients with chronic myelogenous leukemia in blast crisis （CML-BC）,but long-term therapeutic effects are not satisfactory.