摘要
目的观察伊马替尼治疗慢性粒细胞白血病慢性期(CML-CP)患者3个月时断裂点簇集区/艾贝尔逊白血病病毒(BCR/ABL)IS及BCR/ABL拷贝数下降率的变化,进行早期预后评估,探寻最佳换药时机。方法选取2013年9月—2015年12月连云港市第一人民医院收治的初诊CML-CP患者35例,予第一代酪氨酸激酶抑制剂(TKI)伊马替尼400 mg/d治疗,观察治疗3个月时BCR/ABL_(IS)及BCR/ABL拷贝数下降率对治疗12个月时分子学反应的影响。结果治疗3个月时BCR/ABL_(IS)≤10%的患者29例,随访至治疗12个月时10例达到完全分子学反应(CMR),14例达到主要分子学反应(MMR),余5例未达到分子学缓解;BCR/ABL_(IS)>10%的患者6例,仅1例达到MMR,余5例未达到分子学缓解。治疗3个月时BCR/ABL_(IS)≤10%者较BCR/ABL_(IS)>10%者治疗12个月时分子学反应程度更高(u=-2.456,P=0.014)。治疗3个月时BCR/ABL拷贝数下降率≥90%的患者19例,随访至治疗12个月时均取得分子学缓解,其中10例达到CMR,9例达到MMR;BCR/ABL拷贝数下降率<90%的患者16例,5例达到MMR,余11例未获得分子学缓解。治疗3个月时BCR/ABL拷贝数下降率≥90%者较下降率<90%者治疗12个月时分子学反应程度更高(u=-2.803,P=0.005)。治疗3个月时BCR/ABL_(IS)≤10%、BCR/ABL拷贝数下降率≥90%的患者19例,治疗12个月时10例达到CMR,9例达到MMR,均取得分子学缓解;BCR/ABL_(IS)≤10%、BCR/ABL拷贝数下降率<90%的患者10例,治疗12个月时5例取得MMR、5例未获得分子学缓解;BCR/ABL_(IS)>10%、BCR/ABL拷贝数下降率<90%的患者6例,治疗12个月时均未获得MMR;无患者同时符合BCR/ABL_(IS)>10%及BCR/ABL拷贝数下降率≥90%。治疗3个月时不同BCR/ABL_(IS)及BCR/ABL拷贝数下降率患者治疗12个月时分子学反应比较,差异有统计学意义(u=12.977,P=0.002)。结论治疗3个月时BCR/ABL_(IS)、BCR/ABL拷贝数下降率对治疗12个月时分子学反应均有预测作用,联合观察两项指标可能更有意义。对�
Objective To dynamically investigate the changes of the breakpoint cluster region-Abelson leukemia virusinternational scale(BCR/ABL)IS values and the reduction in BCR/ABL copy numbers in patients with chronic myelogenous leukemia-chronic phase(CML-CP)at 3 months following imatinib treatment,and given early prognostic evaluation,to explore the optimal timing for changing medications.Methods A total of 35 first-visit CML-CP patients admitted to the First People's Hospital of Lianyungang from September 2013 to December 2015 were enrolled and given treatment with the first generation tyrosine kinase inhibitor(TKI),imatinib,at a daily dose of 400 mg.The effects of BCR/ABLIS values and BCR/ABL copy number reductions at 3 months after treatment on the molecular responses at 12 months after treatment were evaluated.Results There were 29 patients with≤10%BCR/ABLIS at 3 months after imatinib treatment,and there were 10 cases with complete molecular response(CMR)and 14 cases with major molecular response(MMR)at 12 months after treatment,with only five cases failing in molecular remission.Of the six cases with>10%BCR/ABLIS at 3 months after imatinib treatment,only one case achieved MMR and five cases failed in molecular remission at 12 months after treatment.The degree of molecular response at 12 months after imatinib treatment was higher in patients with≤10%BCR/ABLIS at 3 months after treatment than in those with>10%BCR/ABLIS(u=-2.456,P=0.014).There were 19 patients with≥90%reductions in BCR/ABL copy numbers at 3 months after imatinib treatment,and all achieved molecular remission at 12 months after treatment,including 10 cases with CMR and nine cases with MMR.Among the 16 cases with<90%reductions in BCR/ABL copy numbers at 3 months after treatment,five cases achieved MMR and the other 11 cases failed in molecular remission at 12 months after treatment.The degree of molecular response at 12 months after imatinib treatment was greater in patients with≥90%reductions in BCR/ABL copy numbers at 3 months after treatment
作者
蔡志梅
陈泽
王莹
吴小谢
薛连国
魏计峰
赵利东
CAI Zhi-mei;CHEN Ze;WANG Ying;WU Xiao-xie;XUE Lian-guo;WEI Ji-feng;ZHAO Lidong(The First People's Hospital of Lianyungang City/Xuzhou Medical University Affiliated Hospital of Lianyungang,Lianyungang 222002,China)
出处
《中国全科医学》
CAS
北大核心
2018年第23期2814-2817,2822,共5页
Chinese General Practice
