索拉非尼在治疗Fms样酪氨酸激酶3基因内部串联重复突变阳性急性髓系白血病中的临床分析

Clinical analysis of sorafenib in treatment of acute myeloid leukemia with FLT3-ITD mutation positive

目的分析伴有Fms样酪氨酸激酶3基因内部串联重复(FLT3-ITD)阳性急性髓系白血病(AML)患者的临床特征及预后,探析索拉非尼在该类白血病中的治疗效果。方法回顾性分析2015年6月至2018年6月该院40例初治伴FLT3-ITD突变的AML患者的临床资料,分析该类患者发病时的临床特征,并对比分析联合或不联合索拉非尼治疗的疗效,且进一步观察对于初治不缓解患者加用索拉非尼的治疗效果。结果40例伴FLT3-ITD突变的AML患者中,M5型所占比例最高(50%),外周血白细胞计数中位数为88.9×10^9/L,初治高白细胞计数患者占90%,骨髓原始细胞中位数0.718。40例患者初治总诱导缓解率为57.50%,联合索拉非尼诱导缓解率为83.33%,单纯化疗诱导缓解率为36.36%,差异具有统计学意义(P<0.05),14例单纯化疗组初治不缓解病人有10例患者加用索拉非尼再次诱导治疗,其中7例达完全缓解,2例部分缓解,1例不缓解。所有患者口服索拉非尼均能耐受。结论伴有FLT3-ITD突变的急性髓系白血病,通常初发时高白细胞计数,骨髓原始细胞负荷高,常规诱导缓解率低,预后差,而索拉非尼能明显改善该类白血病的诱导缓解率,能够改善患者生存时间,值得临床应用。

【Objective】To analyze the clinical characteristics and prognosis of patients with acute myeloid leukemia(AML)with Fms-like tyrosine kinase 3 gene-internal tandem duplication(FLT3-ITD),and to investigate the therapeutic effect of sorafenib in this type of leukemia.【Methods】The clinical data of 40 patients with FTT3-ITD mutation in our hospital from June 2015 to June 2018 were retrospectively analyzed,the clinical characteristics of the patients at the time of onset were analyzed,and the curative effect of combined or not combined with sorafenib was compared.Further observation was made on the effect of using sorafenib in patients with initial treatment.【Results】M5 accounted for the highest proportion(50%)of AML patients with FLT3-ITD mutation,median peripheral white blood cell count was 88.9×10^9/L,patients with initial high white blood cell count accounted for 90%,and median bone marrow protocell was 0.718.The total induced remission rate of 40 patients was 57.5%,which was 83.33%in treatment combined with sorafenib,and 36.36%in chemotherapy alone.The difference was statistically significant(P<0.05).In 14 patients with primary remission in the chemotherapy group,10 patients were treated with sorafenib again,of which 7 were CR,2 were PR,and 1 was NR.All patients can tolerate sorafenib orally.【Conclusion】Acute myeloid leukemia with FLT3-ITD mutations,usually with high white blood cell count at initial onset,high bone marrow primitive cell load,low conventional induced remission rate,and poor prognosis,and sorafenib can significantly improve the induced remission rate of this type of leukemia.It can improve the patient's survival time and is worthy of clinical application.