摘要
目的:研究单中心慢性髓细胞白血病(CML)酪氨酸激酶抑制剂(TKI)治疗后自动停药患者的临床特征及转归情况。方法:回顾性分析2015年6月1日至2019年12月31日在本院长期随访并主动停用TKI的35例CML患者的临床资料,分析患者主动停药后无治疗缓解(TFR)的获得情况及其影响因素。结果:35例患者累积服用TKI中位时间为72(35-173)个月,其中8例患者有减停药史。全部患者在停药前获得主要分子学缓解(MMR)及以上疗效。患者达到MMR中位时间为开始服用TKI后15(3-75)个月,停药前MMR维持时间为55(13-164)个月。停药后中位随访20.3(3-57.9)个月,22例(62.8%)患者获得TFR,其中2例(5.71%)患者因生育停用TKI 12个月以上后重启治疗,停药期间维持MMR。13例(37.1%)患者失去MMR,9例停药后失去MMR的患者再启动药物治疗,其中5例重启后已获得MR 4.0以上疗效,中位时间为3(2-5)个月。随访全部患者,未发现疾病进展。本组患者经统计学分析显示,12个月TFR率为57.8%,24个月TFR率为51.8%。本研究比较了中位累积TKI治疗时间、中位累积MMR时间、达到MMR时间、中位诊断年龄、Sokal积分、是否具有TKI减停史、停药前使用二代TKI,未发现与分子学复发相关具有统计学差异的临床参数。结论:本中心达停药标准的CML患者能够安全停用TKI。
Objective: To investigate the clinical characteristics of the patients with chronic myeloid leukemia( CML) discontinued tyrosine kinase inhibitors( TKI) therapy and the outcome of the patients. Methods: 35 cases of CML patients experienced initiative discontinuation of TKI therapy in our hospital from June 1 st 2015 to December 31 th2019 were retrospectively analyzed. The TFR of the patients and the factors affecting it were analyzed. Results: The median duration of TKI administration was 72( range 35-173) months in the 35 patients. Among these patients,8 had experienced TKI dose reduction or suspension. All the enrolled patients have achieved at least MMR. The median time for these patients achieving MMR was 15( range 3-75) months after administration of TKI,and for MMR maintenance before TKI suspension was 55( range 13-164) months. After TKI withdrawal the median follow up time was 20. 3( range 3-57. 9) months,22 out of 35 patients kept TFR,among them,2( 5. 71%) patients restarted TKI after 12 month suspension,and maintained MMR during suspension. 13( 37.1%) patients lost MMR,among them,9 patients restarted TKI treatment,and 5 of them achieved MR4.0 after the median duration of 3( 2-5) month. No patients were found to have disease progression. The estimated TFR rate was 57. 8% and 51. 8% at 12 and 24 months after discontinuation,respectively. Other clinical characteristic related to relapse were also analyzed,including the cumulative TKI administration duration,cumulative MMR duration,time to achieve MMR,median age at diagnosis, risk stratification by Sokal score,TKI dose reduction and discontinuation history,and second-generation TKI administration before stopping TKI,however,no statistical difference was found. Conclusion: TKI discontinuation is practical for CML patients in our center.
作者
赵晓丽
洪鸣
乔纯
孙倩
朱晗
王帅
李建勇
钱思轩
朱雨
ZHAOXiao-Li;HONG Ming;QIAO Chun;SUN Qian;ZHU Han;WANG Shuai;LI Jian-Yong;QIAN Si-Xuan;ZHU Yu(Department of Hematology,The First Affiliated Hospital of Nanjing Medical University,Jiangsu Provincial People's Hospital,Nanjing 210029,Jiangsu Province,China)
出处
《中国实验血液学杂志》
CAS
CSCD
北大核心
2021年第6期1746-1751,共6页
Journal of Experimental Hematology
关键词
慢性髓细胞白血病
主动停药
无治疗缓解
chronic myeloid leukemia
discontinuation
treatment free remission
