甲磺酸伊马替尼对慢性髓系白血病慢性期及进展期的疗效及耐药的对比分析

Comparative Analysis of Efficacy and Drug Resistance of Imatinib in Patients with Chronic Myeloid Leukemia at Chronic and Advanced Phases

目的:对比分析甲磺酸伊马替尼治疗慢性髓系白血病(CML)慢性期(CP)及进展期(加速期+急变期,AP+BC)的疗效及耐药情况。方法:42例CM L患者持续口服甲磺酸伊马替尼400 mg/d(慢性期,29例)或600 mg/d(进展期,13例,其中AP 9例,BC 4例)。中位追踪至24个月(3-42个月)。结果:CP组的完全血液学缓解率(CHR)、主要细胞遗传学缓解率(MCyR)及完全分子学缓解率(CMoR)分别为100%、89.6%和20.1%,进展期患者分别为46.2%、30.8%和0,CP组患者42个月生存率为76.7%,进展期组为39.2%,两组差异有统计学意义(P<0.05)。进展期组严重血液学不良反应发生率高于CP组。本研究42例CM L患者中共有13例(31.0%)患者出现耐药,其中进展期组9例,耐药率显著高于CP组。相关因素分析显示,进展期和低于标准剂量治疗对耐药的影响具有统计学意义。结论:甲磺酸伊马替尼治疗CML各期患者均能取得一定疗效,以慢性期疗效更为显著,早期获得MCyR为CML患者获得长期生存的重要因素,耐药是影响甲磺酸伊马替尼疗效的重要因素,疾病晚期耐药发生率明显升高。

Objective:To compare the efficacy and drug resistance of imatinib in patients with chronic myeloid leukemia(CML) at chronic phase(CP) and advanced phase(accelerated phase and blast crisis(AP + BC).Methods:Forty-two patients with CML were treated with imatinib of different doses(CP 400 mg/d,AP + BC 600 mg/d),and the efficacy and drug resistance of the 2 groups were compared.The median follow-up time was 24 months(3-42months).Results:The complete hematological remission rate(CHR),the major cytogenetic remission rate(MCyR)and complete molecular remission rate(CMoR) in the CP group were 100%,89.6%and 20.1%respectively,while those in advanced phase group were 46.2%,30.8%and 0;survival rate of 42 months in CP patients was 76.7%,and that in advanced phase group was 39.2%,the difference between them was statistically significant(P < 0.05).The incidence of severe hematologic adverse reaction in advanced phase group was higher than that in CP Group;among 42 cases of CML,the drug-resistance happened in 13 cases,out of them 9 cases was CML in advanced phase;the drug resistance rate in CML in advanced phase group(69.2%) was significantly higher than that in CML-CP group(13.8%).The correlation factor analysis showed that the effects of the advanced phase and the lower dose of the drug were statistically significant.Conclusion:Imatinib can provide certain curative effect for CML patients at different phases,especially for the patients at chronic phase;the early MCyR for patients with CML is an important factor in longterm survival;drug resistance is an important factor affecting the efficacy of imatinib;The incidence of imatinib drug resistance at the late stage has been found to be higher.