伊马替尼治疗慢性粒细胞白血病疗效分析

Efficacy and safety evaluation of imatinib in treatment of patients with chronic myeloid leukemia

目的分析伊马替尼治疗慢性粒细胞白血病(CML)的疗效,进一步探讨影响伊马替尼疗效的因素。方法63例慢性粒细胞白血病患者,给予口服伊马替尼治疗;其中慢性期(CP)51例,加速期(AP)5例,急变期(BP)7例。结果完全血液学缓解率(CHR):CP94.1%(48/51),AP40.0%(2/5),BP28.6%(2/7),累计82.5%(52/63);完全遗传学缓解率(CCR):CP60.8%(31/51),AP20.0%(1/5),BP14.3%(1/7),累计52.4%(33/63);部分遗传学缓解率(MCR):CP82.4%(42/51),AP40.0%(2/5),BP28.6%(2/7),累计73.0%(46/63)。可评估分子效应的21例患者中,8例达完全分子效应(38.1%),4例发生主要分子效应(19.0%),累计57.1%(12/21)。血液学不良反应主要为不同程度的血细胞减少和骨髓抑制,可通过调整剂量或药物治疗控制。非血液学不良反应(如恶心、水肿等)发生率较高,但大多程度轻微且可耐受或自行消失。结论伊马替尼治疗慢性粒细胞白血病有较高的完全血液学缓解率和遗传学缓解率及分子效应,不良反应轻微。常见血液学不良反应为中性粒细胞减少、血小板减少,非血液学不良反应为消化道反应及轻度水肿,大多程度轻微,患者能够耐受。个体化正规治疗有望进一步提高疗效。

Objective To evaluate the efficacy and safety of imatinib in treatment of adult patients with chronic myeloid leukemia（CML）. Methods A total of 63 aduh CML patients, among them, 51 in chronic phase（CP）, 5 in accelerated phase（AP） and 7 in blast crisis（BP） were treated with oral imatinib respectively. Results There were 82.5% of patients achieving complete hematologic response （CP 94.1 %, AP 40.0 %, BP 28.6 %） ; 52.4 % of patients achieving complete cytogenetic response （CP 60.8%, AP 20.0%, BP 14.3%）;73.0% of patients achieving major cytogenetic response （CP 82.4% ,AP 40.0% ,BP 28.6%）. The rates were significantly higher in patients with CP than in those with AP and BP（ P 〈0.05）. 21 patients could be evaluated for molecular response. Imatinib induced complete molecular response in 8 （38.1%） patients and major molecular response in 4 （19.0 % ） patients. The main hematologic adverse effects were disparity hematocytopenia and myelosuppression, which could be lessened through adjusted dose. Conclusion Imatinib induces high rate of cytogenetic and hematologic responses in patients with Philadelphia chromosome positive CML. The adverse effects are mild and manageable or do not need treatment. Curative effect could be elevated by individual regular treatment.