达沙替尼治疗费城染色体阳性急性淋巴细胞白血病十例并文献复习

Dasatinib for the treatment of Philadelphia chromosome-positive acute lymphoblastic leukemia：report of ten cases and review of literature

目的：探讨二代酪氨酸激酶抑制剂达沙替尼治疗费城染色体阳性（Ph^＋）成年人急性淋巴细胞白血病（ALL）的疗效及安全性。方法对应用达沙替尼治疗的10例成年 Ph^＋ ALL 患者的临床资料进行回顾性分析并复习相关文献。结果10例应用达沙替尼治疗的 Ph^＋ ALL 患者均在7周内获得缓解，其中9例获得完全缓解，包括7例在13周内达完全分子学缓解。所有患者的中位总生存时间为13.8个月（5～33个月），中位无病生存时间为10.8个月（4～25个月）。治疗过程中，发生胸腔积液3例，Ⅳ度骨髓抑制4例，血小板极度低下（＜20×10^9／L）6例，经对症治疗均可改善，未出现并发症致死病例，总体安全性高。结论达沙替尼治疗成年人 Ph^＋ ALL 的缓解率高，可提高分子生物学反应，延长患者的生存时间，且安全性高，可作为成年人 Ph^＋ ALL 的一线治疗。

Objective To observe the clinical response and safety of second-generation tyrosine kinase inhibitor dasatinib in the treatment of Philadelphia chromosome-positive acute lymphoblastic leukemia （Ph^＋ ALL）. Methods The clinical data of 10 adult Ph^＋ ALL patients treated with dasatinib were analyzed with review of literatures. Results All the 10 Ph＋ ALL patients treated with dasatinib achieved remission in 7 weeks, including 9 cases of complete remission [7 cases achieved complete molecular remission （CRm） in 13 weeks]. The median overall survival time （OS） was 13.8 months （5-33）, and the median disease-free survival （DFS） time was 10.8 months （4-25）. There were 3 cases of pleural effusion, 4 cases of Ⅳ degree of bone marrow suppression and 6 cases of extremely low blood platelet, which could be that was improved via by symptomatic treatment and, with no case of the death occurred during the treatment of dasatinib, the safety was high. Conclusion Dasatinib can deepen molecular biological reaction and prolonged the survival time of patients in the treatment of adult Ph^＋ ALL, with high remission rate and safety, and which can be considered as first-line treatment.