Synchronous diagnosis and treatment of acute myeloid leukemia and chronic lymphocytic leukemia:Two case reports

BACKGROUND The concurrence of acute myeloid leukemia(AML)and chronic lymphocytic leukemia(CLL)is rare.Previous reports of such cases have focused mainly on clinical diagnosis and characteristics,so the mechanism remains unclear,and therapy options have been poorly explored.CASE SUMMARY Here,we report two cases of synchronous AML and CLL.Flow cytometry revealed two distinct abnormal cell populations(myeloblasts and lymphoid cells)according to scatter characteristics.CD5-positive B cell lymphoma with myeloid leukemia invasion was observed on lymph node biopsy.Chemotherapy regimens indicated for both AML and CLL were used in our patients,and our patients achieved complete response after chemotherapy.Next-generation sequencing of 88 genes was performed.CONCLUSION We conclude that early mutation and dysregulation at the hematopoietic stem cell stage and the accumulation of multiple rearrangements may cause the concurrence of CLL and AML.The treatment of infection and combination therapy aimed at the CLL component are significant in the management of patients with concurrent CLL and AML.

Clinical Effect of Imatinib,Nilotinib,and Dasatinib on Chronic Myeloid Leukemia in Chronic Phase

The study was conducted to explore the effect of imatinib,nilotinib,and dasatinib in the treatment of chronic myeloid leukemia(CML)patients.Around 66 patients with CML in chronic phase were selected,subsequently the patients were subdivided into 3 groups with 22 patients in each group:Group A were treated with imatinib;Group B were treated with nilotinib;and Group C were treated with dasatinib.The study showed that,at 18 months of treatment,compared with group A,the molecular biology remission rates of group B and group C were significantly higher,p<0.05;at 6 months and 18 months of treatment,compared with group A,the complete cytogenetic remission rates of group B and group C were significantly higher,p<0.05;and compared with group A,the incidences of vomiting,headache and edema in groups B and C were significantly lower,p<0.05.However,no significant different p>0.05 were observed in the complete hematologic remission rates,and the incidences of neutropenia and thrombocytopenia among the three groups.In summary,nilotinib and dasatinib are effective in the treatment of patients with CML in the chronic phase,which is significantly better than imatinib treatment.

Gene mutations in a patient with chronic myelomonocytic leukemia and changes upon progression to acute myeloid leukemia and during treatment

Objective Chronic myelomonocytic leukemia(CMML) has been categorized as an uncommon hematological malignancy with overlapping features of myelodysplastic syndromes(MDS) and myeloproliferative neoplasms that have an inherent risk of progressing to acute myeloid leukemia(AML). Methods This study presents a case of confirmed CMML combined with M protein, in which the molecular changes upon progression to AML and under decitabine(DAC) plus bortezomib therapy were reported by tracking variant allele frequency(VAF) of mutations in a series of bone marrow samples. Results First, variable sensitivity of clones was observed during DAC treatment, and incomplete mutation clearance may be associated with low overall response rate and unsustained response. Secondly, DAC cannot prevent the new genetic alterations and accumulation of genetic progression on treatment, leading to acute transformation. Finally, autoimmunity was found to have acted as an important pathogenetic factor, increasing the additive mutations that further drive the clonal evolution in CMML. Conclusion Overall, changes in mutations and clonal architecture during CMML progression or treatment are predictive of an early evaluation of therapeutic strategies in CMML.

Oxidative Stress and Antioxidant Status in Acute and Chronic Myeloid Leukemia Patients

Oxidative stress, a pervasive condition of increased number of reactive oxygen species, is now recognized to be prominent feature of various diseases and their progression. The relationship between antioxidants and levels of well-known markers of oxidative stress, measured as lipid peroxides and oxidized proteins reflect health indices. The aim of this study is to evaluate the extent of oxidative stress and antioxidant status in acute and chronic myeloid leukemia patients. The present study included 60 patients selected using standard questionnaire based on age, family history, Body Mass Index (BMI), dietary intake, with no other complications and 30 age and sex-matched healthy subjects. The median age of myeloid leukemia patients was 43 years and that of controls was 42 years. Out of 60 myeloid leukemia patients, 30 were in acute and 30 were in chronic state. Oxidative stress and antioxidant status were evaluated in the patients and in the controls by assessing standard oxidative stress markers viz. plasma and erythrocyte lipid peroxide levels in terms of malondialdehyde and oxidized proteins as protein carbonyls whereas antioxidant status was assessed in terms of serum non enzymatic antioxidant levels. There was a significant increase (p 0.01) in plasma and erythrocyte lipid peroxidation and protein oxidation in acute and chronic myeloid leukemia patients as compared to healthy subjects. Antioxidant status as indicated by the levels of non-enzymatic antioxidants viz. erythrocyte reduced glutathione (GSH), serum β carotene, vitamin A & C and ceruloplasmin was found to be significantly decreased (p 0.01) in both the leukemia patients as compared to healthy participants. However, chronic myeloid leukemia patients had significantly (p 0.05) higher oxidative stress and lower antioxidant status as compared to acute myeloid leukemia patients.

A novel t(3;12)(q21;p13) translocation in a patient with accelerated chronic myeloid leukemia after imatinib and nilotinib therapy

The acquisition of secondary chromosomal aberrations in chronic myeloid leukemia (CML) patients with Philadelphia chromosome-positive (Ph+) karyotype signifies clonal evolution associated with the progression of the disease to its accelerated or blastic phase. Therefore, these aberrations have clinical and biological significance. T(3;12)(q26;p13), which is a recurrent chromosomal aberration observed in myeloid malignancies, is typically associated with dysplasia of megakaryocytes, multilineage involvement, short duration of any blastic phase, and extremely poor prognosis. We have identified a recurrent reciprocal translocation between chromosomes 3 and 12 with different breakpoint at bands 3q21 in the malignant cells from a 28-year-old man. The patient was initially diagnosed as having Ph+ CML in the chronic phase. The t(3;12)(q21;p13) translocation occurred 4 years after the patient was first diagnosed with CML while undergoing tyrosine kinase inhibitor therapy. We confirmed the t(3;12)(q21;p13) translocation via fluorescence in situ hybridization assay by using whole-chromosome paint probes for chromosomes 3 and 12. Our findings demonstrate that, similar to other recurrent translocations involving 3q26 such as t(3;3) and t(3;21), the t(3;12)(q21;p13) translocation is implicated not only in myelodysplastic syndrome and acute myeloid leukemia but also in the progression of CML. These findings extend the disease spectrum of this cytogenetic aberration.

Bone marrow microenvironment: The guardian of leukemia stem cells

Bone marrow microenvironment (BMM) is the main sanctuary of leukemic stem cells (LSCs) and protects these cells against conventional therapies. However, it may open up an opportunity to target LSCs by breaking the close connection between LSCs and the BMM. The elimination of LSCs is of high importance, since they follow cancer stem cell theory as a part of this population. Based on cancer stem cell theory, a cell with stem cell-like features stands at the apex of the hierarchy and produces a heterogeneous population and governs the disease. Secretion of cytokines, chemokines, and extracellular vesicles, whether through autocrine or paracrine mechanisms by activation of downstream signaling pathways in LSCs, favors their persistence and makes the BMM less hospitable for normal stem cells. While all details about the interactions of the BMM and LSCs remain to be elucidated, some clinical trials have been designed to limit these reciprocal interactions to cure leukemia more effectively. In this review, we focus on chronic myeloid leukemia and acute myeloid leukemia LSCs and their milieu in the bone marrow, how to segregate them from the normal compartment, and finally the possible ways to eliminate these cells.

Characterization of miRNomes in Acute and Chronic Myeloid Leukemia Cell Lines

Myeloid leukemias are highly diverse diseases and have been shown to be associated with microRNA（miRNA） expression aberrations. The present study involved an in-depth miRNome analysis of two human acute myeloid leukemia（AML） cell lines, HL-60 and THP-1, and one human chronic myeloid leukemia（CML） cell line, K562, via massively parallel signature sequencing. mRNA expression profiles of these cell lines that were established previously in our lab facilitated an integrative analysis of miRNA and mRNA expression patterns. miRNA expression profiling followed by differential expression analysis and target prediction suggested numerous miRNA signatures in AML and CML cell lines. Some miRNAs may act as either tumor suppressors or oncomiRs in AML and CML by targeting key genes in AML and CML pathways. Expression patterns of cell type-specific miRNAs could partially reflect the characteristics of K562, HL-60 and THP-1 cell lines, such as actin filament-based processes, responsiveness to stimulus and phagocytic activity. miRNAs may also regulate myeloid differentiation, since they usually suppress differentiation regulators. Our study provides a resource to further investigate the employment of miRNAs in human leukemia subtyping, leukemogenesis and myeloid development. In addition, the distinctive miRNA signatures may be potential candidates for the clinical diagnosis, prognosis and treatment of myeloid leukemias.

Pharmacokinetics of generic dasatinib in the management of chronic myeloid leukemia in the chronic phase

Objective To evaluate the pharmacokinetics and bioequivalence of generic dasatinib in patients with chronic myeloid leukemia in the choronie phase(CML-CP).Methods Using randomized,parallel,overlapping,self-

Patient reported outcome of tyrosine kinase inhibitor related side effects and their impact on daily life in Chinese patients with chronic myeloid leukemia in the chronic phase

Objective To explore the impact of patient reported outcome of tyrosine kinase inhibitor(TKI)related side effects on daily life in Chinese patients with chronic myceloid leukemia(CML)in the chronic phase(CP).Methods From May to November in 2014。

A comparison of efficacy and safety between Chinese generic imatinib and branded imatinib in patients with newly-diagnosed chronic myeloid leukemia in the chronic phase:a single-center prospective cohort study

Objective To compare the efficacy and safety between Chinese generic imatinib(Xinwei~,Jiansu Hansoh Pharmaceutical Group Co.,Ltd.)and branded imatinib(Glivec~,Novartis)in patients with newly-diagnosed chronic myeloid leukemia in chronic phase(CML-CP).Methods Patients with newly diagnosed CML-CP

Risk factors for chronic graft-versus-host disease after anti-thymocyte globulin-based haploidentical hematopoietic stem cell transplantation in acute myeloid leukemia

Chronic graft-versus-host disease(cGVHD)is a major complication following unmanipulated haploidentical hematopoietic stem cell transplantation(haplo-HSCT).We aimed to identify the risk factors for cGVHD in patients who underwent anti-thymocyte globulin-based haplo-HSCT for acute myeloid leukemia(n=280).The diagnosis of cGVHD was in accordance with the National Institutes of Health consensus criteria.A total of 169 patients suffered from cGVHD.The patients who had 3 loci mismatched had a higher 8-year incidence of cGVHD(total,66.0%vs.53.7%,P=0.031;moderate to severe,42.4%vs.30.1%,P=0.036)than the patients who had 1 to 2 loci mismatched.The patients who had maternal donors had a higher 8-year incidence of moderate to severe cGVHD(49.2%vs.32.9%,P=0.024)compared with the patients who had other donors.The patients who had grades III to IV acute GVHD(aGVHD)had higher 8-year incidence of cGVHD(total,88.0%vs.50.4%,P<0.001;moderate to severe,68.0%vs.27.0%,P<0.001)compared with the patients without aGVHD.In multivariate analysis,grades III to IV aGVHD was the only independent risk factor for cGVHD.Thus,further interventions should be considered in patients with severe aGVHD to prevent cGVHD.

Retrospective study of a cohort of adult patients with hematological malignancies in a tropical area

AIM: To review the characteristics of hematological malignancies in tropical areas, and to focus on the specific difficulties regarding their management. METHODS: This is a retrospective narrative review of cases of patients with hematological malignancies. All medical files of patients with malignant disease whose treatment was coordinated by the HematoOncology service of the Cayenne Hospital in French Guiana between the 1st of January 2010 and the 31 st of December 2012 were reviewed. Clinical data were extracted from the medical files and included: Demographic data, comorbidities, serological status for human immunodeficiency virus, human T-lymphotropic virus 1(HTLV1), hepatitis B virus and hepatitis C virusinfections, cytology and pathology diagnoses, disease extension, treatment, organization of disease management, and follow-up. The subgroup of patients with hematological malignancies and virus-related malignancies were reviewed. Cases involving patients with Kaposi sarcoma, and information on solid tumor occurrence in virus-infected patients in the whole patient population were included. Since the data were rendered anonymous, no informed consent was obtained from the patients for this retrospective analysis. Data were compiled using EXCEL&#174; software, and the data presentation is descriptive only. The references search was guided by the nature of the data and discussion. RESULTS: In total, the clinical files of 594 patients(pts) were reviewed. Hematological malignancies were observed in 87 patients, and Kaposi sarcoma in 2 patients. In total, 70 patients had a viral infection, and 34 of these also had hematological malignancies. The hematological diagnoses were: Multiple myeloma in 27 pts, lymphoma(L) in 43 pts, myeloproliferative disorders in 17 pts and Kaposi sarcoma in two patients. The spectrum of non-Hodgkin lymphomas(NHL) was: Burkitt L(1 pt), follicular L(5 pts), chronic lymphocytic leukemia(5 pts), high-grade NHL(9 pts), mucosa-associated lymphoid tissue NHL(4 pts), T-cell lymphoma(4 pts), Adult T-cell lymphoma-leukemia(ATL)/lymphoma/leukemia(12 pts); three patients had Hodgkin disease. The spectrum of myeloproliferative diseases was: Chronic myelogenous leukemia(8 pts), thrombocytemia(5 pts) and acute leukemia(4 pts). There were no polycythemia vera, myelosclerosis, and myelodysplastic diseases. This appears to be due to bias in the recruitment process. The most important observations were: The specificity of HTLV1- related ATL malignancies, and the high incidence of virus infections in patients with hematological malignancies. Further, we noted several limitations regarding the treatment and organization of disease management. These were not related to the health care organization, but were due to a lack of board-certified hematooncology specialists, a lack of access to diagnostic tools(e.g., cytogenetic and molecular diagnosis, imaging techniques), the unavailability of radiotherapy, and the physical distance from mainland France. Yet the geography and cultures of the country also contributed to the encountered difficulties. These same limitations are seen in tropical countries with low and intermediate household incomes, but they are amplified by economic, social, and cultural issues. Thus, there is often little access to diagnostic procedures, adequate clinical management, and an unavailability of suitable medical treatments. Programs have been developed to establish centers of excellence, training in pathology diagnosis, and to provide free access to treatment.CONCLUSION: Management of hematological malignancies in tropical areas requires particular skills regarding specific features of these diseases and in terms of the affected populations, as well as solid public health policies.

An exciting time to launch the World Journal of Hematology

This first issue of the World Journal of Hematology(WJH) marks the birth of a new member of the World Series Journal family and comes at one of the most exciting times in stem cell biology and translational medicine. The pace of discovery in the field of hematology has accelerated signeificantly in recent years, due to important scientific discoveries and new technologies for purification of hematopoietic stem cells and identification of specific stem cell biomarkers; whole genome sequencing using next-generation sequencing technology; and development of molecularly-targeted therapies, leading to the translation of highly promising science into advanced diagnosis and proven targeted therapies for hematopoietic disorders. The WJH is an open-access, peer-reviewed journal, which is officially published on June 6, 2012. The WJH Editorial Board consists of 102 experts in hematology from 26 countries. There is clearly a niche for this new journal, which provides access to all articles without boundaries to all internet users throughout the world. The WJH aims to provide rapid access to high impact publications in fundamental and clinical hematology, with multidisciplinary coverage, through an established system that is targeted at dissemination to the scientific community via online openaccess.

儿童慢性粒细胞白血病慢性期红细胞参数及血清bFGF、TGF-β1、VEGF表达变化分析

目的探究儿童慢性粒细胞白血病(CML)慢性期红细胞参数及血清碱性成纤维细胞生长因子(bFGF)、转化生长因子β1(TGF-β1)及血管内皮生长因子(VEGF)表达变化。方法前瞻性选取2020年1月至2023年1月在首都医科大学附属北京儿童医院进行治疗的54例CML慢性期患儿为研究组,另随机抽取46名同期在本院进行体检的健康儿童为健康对照组。研究组给予酪氨酸激酶抑制剂治疗。比较两组间红细胞参数及血清bFGF、TGF-β1、VEGF表达变化,并比较研究组治疗前后红细胞参数及血清bFGF、TGF-β1、VEGF表达水平。结果研究组的RBC、血红蛋白、红细胞压积(HCT)及平均红细胞血红蛋白浓度(MCHC)水平分别为(3.45±0.04)×10^(12)/L、(102.33±1.15)g/L、(32.03±0.61)%、322.15±2.58,均显著低于对照组[(4.98±0.03)×10^(12)/L、(149.78±1.88)g/L、(44.33±0.31)%、334.12±0.77],平均红细胞体积(MCV)、平均红细胞血红蛋白含量(MCH)及红细胞体积分布宽度(RDW)水平分别为(91.44±0.77)fL、(33.15±2.55)pg、(17.55±0.12)%,均显著高于对照组[(89.88±0.34)fL、(30.24±0.16)pg、(12.66±0.11)%],差异均有统计学意义(P<0.05)。研究组的血清bFGF、VEGF水平分别为(30.66±9.66)、(128.68±30.58)pg/mL,均显著高于对照组[(5.26±1.54)、(70.66±11.26)pg/mL],TGF-β1水平为(38.22±8.06)μg/L,显著低于对照组[(78.66±8.13)μg/L],差异均有统计学意义(P<0.05)。治疗后,研究组患儿的RBC、血红蛋白、HCT、MCV及MCH水平均较治疗前显著降低,MCHC及RDW水平均较治疗前显著升高,差异均有统计学意义(P<0.05)。研究组治疗后的血清bFGF、VEGF水平均较治疗前显著降低,TGF-β1水平较治疗前显著升高,差异均有统计学意义(P<0.05)。结论在儿童CML慢性期患儿中可见血细胞参数明显异常,血清bFGF、VEGF水平显著升高,TGF-β1水平显著降低。酪氨酸激酶抑制剂治疗CML慢性期能有效改善患儿红细胞形态及功能,抑制肿瘤细胞生长,临床疗效显著,值得临床推广使用。

吲哚美辛对慢性粒细胞白血病急变期CD34^+细胞的影响研究

目的探讨吲哚美辛(IN)对慢性粒细胞白血病(简称慢粒)急变期CD34+细胞凋亡和周期的影响,并从Wnt/β-catenin信号通路初步探讨其可能的分子机制。方法采用免疫磁珠分选技术分选慢粒慢性期、急变期患者骨髓标本和正常脐带血标本中的CD34+细胞,流式细胞术鉴定其分选纯度,瑞氏染色观察其细胞形态,采用免疫荧光技术检测CD34+细胞中β-catenin和BCR/ABL的表达及定位。使用IN联合伊马替尼(IM)处理CD34+细胞,免疫荧光技术检测β-catenin蛋白变化,瑞氏染色和流式细胞术观察细胞凋亡及细胞周期,定量PCR检测靶基因c-myc和cyclin D1的m RNA水平,流式细胞术和免疫荧光技术检测BCR/ABL蛋白变化。结果成功分选出CD34+细胞,纯度达90%以上;β-catenin和BCR/ABL均在慢粒急变期CD34+细胞中高表达,主要定位于胞质。IN与IM联用能够显著抑制慢粒急变期CD34+细胞中β-catenin的表达,使慢粒急变期CD34+细胞的细胞周期被阻滞在G0/G1期,明显增加细胞的凋亡,明显降低c-myc和cyclin D1的m RNA水平,并使BCR/ABL的蛋白水平显著下降,但对正常CD34+细胞没有影响。结论 IN通过影响细胞周期和细胞凋亡,增强IM对慢粒急变期CD34+细胞的杀伤力,其机制可能是与降低β-catenin的表达,抑制c-myc和cyclin D1的转录及BCR/ABL的蛋白水平有关。

慢性粒细胞白血病细胞中Skp2的表达及其临床意义

目的 研究慢性粒细胞白血病 (CML)细胞中S期激酶相关蛋白 2 (Skp2 )的表达及其与p2 7的关系。方法 用免疫细胞化学染色和逆转录聚合酶链反应 (RT PCR)分别检测CML细胞中Skp2和p2 7蛋白水平及转录水平的表达。结果 免疫细胞化学染色显示 ,CML细胞Skp2蛋白表达增高 (14 .3%± 2 .9% ) ,与正常对照 (8.6 %± 0 .9% )相比有显著性差异 (P <0 .0 5 ) ;CML细胞中Skp2蛋白和p2 7蛋白呈负相关 (r=- 0 .75 ,P =0 .0 0 1)。但RT PCR结果显示 ,Skp2蛋白过度表达的CML细胞中p2 7mRNA未见明显变化。结论 Skp2在调控p2 7蛋白表达过程中起重要作用 。

PCR检测降钙素基因甲基化及其在某些恶性血液病中的意义

目的 :探讨急性非淋巴细胞白血病 (acutenonlymphoblasticleukecia ,ANLL)、骨髓增生异常综合征(myelodysplasticsyndrome ,MDS)和慢性粒细胞白血病 (chronicmyeloidleukemia ,CML)患者降钙素基因 (calcitoningene ,CT基因 )甲基化状况及其意义。方法 :利用限制性内切酶和多聚酶链反应 ( polymerasechainreaction ,PCR)技术。结果 :72 % ( 18/ 2 5 )的ANLL和 6 0 % ( 6 / 10 )的MDS患者有CT基因高度甲基化 ,在CML慢性期CT基因甲基化阳性率为 2 3 .8% ( 5 / 2 1) ,而急变期阳性率为 80 % ( 8/ 10 ) ,两者之间有显著性差异 ,系列稀释法发现本试验敏感性至少达 10 3 水平。结论 :CT基因高度甲基化较广泛地存在于ANLL、MDS和CML急变期 ,是ANLL和MDS患者白血病细胞克隆以及CML进展和急变的一个共同的分子标志 。

p15^(INK4B)基因甲基化在急性粒细胞白血病和慢性粒细胞白血病中的研究

为探索 p15 INK4B基因在CpG岛高甲基化对白血病发病机制的重要作用 ,应用敏感的甲基化特异的MSP PCR的测定方法 ,测定了 p15 INK4B基因在急性粒细胞白血病 (AML)和慢性粒细胞白血病 (CML)中甲基化的表达变化。研究结果表明 ,p15 INK4B基因操纵区在AML和CML中的甲基化发生率分别为 83.9% (2 6/ 31)和 0 % (0 / 2 8)。结论提示 :甲基化是p15 INK4B基因在AML中主要的失活方式之一 ,并可在病程进展中出现甲基化 ,使病情加重 ;在CML中无甲基化的发生 ,说明p15

PLZF-RARα/RARα-PLZF双阳性转基因小鼠发生白血病模型研究

本研究目的是从生物整体水平上研究PLZFRARα/RARαPLZF双融合基因的表达在急性早幼粒细胞白血病(APL)发病中的作用及发病机制。通过交配建立PLZFRARα/RARαPLZF双阳性转基因小鼠(TM)模型;采用PCR、RTPCR方法检测融合基因的整合和表达;应用血象、骨髓象、病理和流式细胞术等对疾病表型进行检测分析;并观察全反式维甲酸(ATRA)或ATRA与tricostatinA(TSA)联合用药对PLZFRARα/RARαPLZF双阳性转基因小鼠骨髓细胞的作用。结果表明,在近18个月的时间观察到51只PLZFRARα/RARαPLZF双阳性转基因小鼠中有5只小鼠发病,发病率约10%,与我所同期的仅PLZFRARα转基因阳性小鼠11.3%的发病率相似。发病时间均在6月龄以后,与PLZFRARα转基因阳性发病小鼠相比示提前,但疾病表型不同,2只(40%)为急性早幼粒细胞白血病(APL)改变,3只(60%)为慢性粒细胞白血病(CML)改变。ATRA处理组的骨髓细胞形态无改变,而ATRA+TSA组骨髓原始细胞核浆比例降低,染色质固缩,呈现粒细胞分化趋势。结论PLZFRARα/RARαPLZFTM小鼠发病存在异质性,其骨髓细胞对ATRA无反应,而ATRA与TSA联合用药可诱导骨髓原始早幼粒细胞分化。

甲磺酸马替尼治疗慢性髓细胞白血病急性髓性变的疗效

背景与目的:慢性髓细胞白血病急性髓性变后,治疗非常困难,预后极差。本文旨在探讨特异性BCR/ABL酪氨酸激酶抑制剂(甲磺酸马替尼,格列卫)治疗慢性髓细胞白血病急性髓性变的疗效。方法:甲磺酸马替尼治疗组19例与历史对照组22例均先用含阿糖胞苷的标准化疗方案诱导治疗2疗程后,治疗组用甲磺酸马替尼400mg/d继续巩固或诱导治疗,治疗4周如无效,则将剂量增加至600mg/d,继续治疗8周;如有效,则用该剂量继续维持,仍无效则停用。历史对照组则采用其他方案继续巩固或诱导治疗。结果:治疗组标准诱导治疗无效的16例患者用甲磺酸马替尼治疗,6例(38%)取得完全的血液学缓解,获大部分遗传学效应;2例(13%)获部分血液学缓解,1例(6%)回到慢性期,获小部分遗传学效应;总的血液学有效率为56%。存活1年者6例(38%)。对照组诱导治疗无效的18例患者采用其他方案诱导化疗,仅2例(11%)取得完全的血液学缓解;1例(6%)获部分血液学缓解,总有效率为17%;1年内存活者仅1例(6%)。两组比较,差异有显著性(P<0.05)。结论:甲磺酸马替尼治疗慢性髓细胞白血病急性髓性变疗效高、生存时间延长,且耐受性好。但仍存在复发和耐药问题。