本文選題：慢性髓系白血病　切入點：酪氨酸激酶抑制劑　出處：《中國實驗血液學(xué)雜志》2017年06期

【摘要】：目的:評價酪氨酸激酶抑制劑(TKI)治療慢性髓系白血病(CML)的療效,探討獲得深層分子反應(yīng)(DMR)的影響因素。方法:對我院接受TKI治療的131例成人CML患者的臨床資料及隨訪結(jié)果進行了分析,評價各時間點治療反應(yīng)的療效,分析影響獲得MR~(4.5)的相關(guān)因素。結(jié)果:131例患者中位隨訪24(6-120)個月,其中30例在中位伊馬替尼治療12(1-69.6)個月?lián)Q為尼洛替尼治療,13例在中位伊馬替尼治療31.2(3.1-87.6)個月時換達沙替尼。治療3、6及12個月的獲得主要細胞遺傳學(xué)反應(yīng)(MCyR)率分別為78%、79.4%及95.9%,獲得完全細胞遺傳學(xué)反應(yīng)(CCyR)率分別為48.8%、66.7%及73.5%。60%的患者3個月時BCR-ABL~(IS)10%,6個月BCR-ABL~(IS)1%占56.3%,12個月BCR-ABL~(IS)0.1%達55.2%。持續(xù)伊馬替尼治療組中53例(60.9%)獲得MR~(4.5),31例(35.6%)能夠獲得穩(wěn)定的MR~(4.5)。多因素分析顯示,性別、診斷時WBC計數(shù)及3個月BCR-ABL~(IS)水平是獲得MR~(4.5)的獨立影響因素,3個月BCR-ABL~(IS)水平是獲得穩(wěn)定MR~(4.5)的獨立影響因素。換第二代TKI組中18例(40.9%)獲得MR~(4.5),3個月BCR-ABL~(IS)水平同樣是獲得MR~(4.5)的獨立影響因素。結(jié)論:伊馬替尼治療新診斷CML患者獲得細胞遺傳學(xué)與分子學(xué)療效優(yōu)異,對于耐藥或不能耐受患者換為第二代TKI同樣能夠獲得滿意的療效且DMR率更高,獲得早期分子反應(yīng)預(yù)測MR~(4.5)和穩(wěn)定的MR~(4.5)的累積發(fā)生率更高。
[Abstract]:Aim: to evaluate the efficacy of tyrosine kinase inhibitor (TKI) in the treatment of chronic myeloid leukemia (CML) and to explore the factors influencing the acquisition of deep molecular response (DMRs).Methods: the clinical data and follow-up results of 131 adult CML patients treated with TKI in our hospital were analyzed.Results A median follow-up of 246-120 months was performed in 131 patients, 30 of whom were treated with imatinib for 121-69.6) months and 13 patients were treated with nilotinib for 31.2n- 3.1-87.6 months, and dasatinib was replaced by dasatinib in the median imatinib treatment for 3.1-87.6 months.In the group of continuous imatinib treatment, 53 cases (60.9 cases) were treated with MRA (4.5 cases) and 35.6 cases (35.6 cases) were able to obtain stable MRA (4.5%).Multivariate analysis showed that sex, WBC count at diagnostic time and 3 months BCR-ABL level were independent influencing factors in obtaining MRR 4.5), and BCR-ABL WBC at 3 months were independent influencing factors for stable MRR 4.5).In the second generation TKI group (n = 18, n = 40.9), the level of BCR-ABL is also an independent factor.Conclusion: imatinib has excellent cytogenetic and molecular efficacy in the treatment of newly diagnosed CML. It can also obtain satisfactory curative effect and higher DMR rate in the second generation TKI for drug-resistant or intolerant patients.The cumulative incidence of early molecular reaction prediction of MRA 4.5) and stable MRA 4.5) was higher.
【作者單位】： 解放軍總醫(yī)院血液科;
【分類號】：R733.72

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