摘要
目的:探讨酪氨酸激酶抑制剂(TKI)治疗慢性粒细胞白血病(CML)患者BCR-ABL^(IS)减半时间(HT)对获得深层分子学反应(DMR)的早期预测价值。方法:回顾性分析本院2014年1月至2022年6月收治的一线予以伊马替尼治疗且具有完整病例资料的初诊CML患者的连续数据。结合患者临床特征及各时点疗效分析,应用Logistic回归模型探索患者获得DMR的独立影响因素联合HT与3个月BCR-ABLIs水平对DMR进行早期预测。结果:单因素与多因素分析结果显示,HT与3个月BCR-ABLIs水平为患者获得MR4、MR4.5、stable MR4.5的独立影响因素(P<0.05)。ROC曲线分析确定HT的最佳截断值为28 d,与HT>28 d的患者相比,HT≤28 d的患者分别在2年、3年和5年更容易获得DMR(74.2%vs 27.3%,71.2%vs 22.7%,63.6%vs 25.0%,均P<0.001)。按照3个月BCR-ABL^(IS)水平及HT将患者分为4组,Kaplan-Meier分析结果显示,BCR-ABL^(IS)≤10%且HT≤28 d组获得累计MR4及MR4.5的概率高于BCR-ABL^(IS)≤10%且HT>28 d组(P<0.05);BCR-ABL^(IS)>10%且HT≤28 d组获得累计MR4及MR4.5的概率高于BCR-ABL^(IS)>10%且HT>28 d组(P<0.05)。结论:除了早期分子学反应(EMR)之外,HT可作为CML疗效的另一重要预测指标,二者联合对于患者获得DMR具有更准确的早期预测价值。
Objective:To investigate the early predictive value of halving time(HT)of BCR-ABL^(IS)for deep molecular response(DMR)in patients with chronic myeloid leukemia(CML)treated with tyrosine kinase inhibitor(TKI).Methods:The continuous data of newly diagnosed CML patients with complete case data and first line imatinib treatment admitted to the Affiliated Hospital of Inner Mongolia Medical University from January 2014 to June 2022 were retrospectively analyzed.Combined with the clinical characteristics of the patients and the efficacy analysis at each time point,a logistic regression model was used to explore the independent influencing factors of DMR,and combined HT of BCR-ABL^(IS)with BCR-ABL^(IS)level at 3 months to predict DMR of the patients.Results:Univariate and multivariate analyses showed that HT and 3-month BCR-ABL^(IS)levels were independent influencing factors for MR4,MR4.5,and stable MR4.5(P<0.05).ROC curve analysis determined that the best cut-off value of HT was 28 days.Compared with patients with HT>28 d,patients with HT≤28 d were more likely to obtain DMR at2,3,and 5 years,respectively(74.2%vs 27.3%,71.2%vs 22.7%,and 63.6%vs 25.0%,all P<0.001).The patients were divided into 4 groups according to BCR-ABL'levels at 3 months and HT.Kaplan-Meier analysis showed that the patients in the BCR-ABL^(IS)≤10%and HT≤28 d group had a higher probability of obtaining cumulative MR4 and MR4.5 than those in the BCR-ABL^(IS)≤10%and HT>28 d group(P<0.05);Patients in the BCR-ABL^(IS)>10%and HT≤28 d group had a higher probability of obtaining cumulative MR4 and MR4.5 than those in the BCR-ABL^(IS)>10%and HT>28 d group(P<0.05).Conclusion:In addition to BCR-ABL^(IS)level,HT of BCR-ABL^(IS)can be used as another important predictor of treatment efficacy in CML patients.The combination of BCR-ABL^(IS)level and HT has a more accurate predictive value for long-term molecular response of CML patients after TKI treatment.
作者
杨岚
曹丽霞
任慧娟
韩艳秋
YANG Lan;CAO Li-Xia;REN Hui-Juan;HAN Yan-Qiu(Department of Hematology,The Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010059,Inner Mongolia Autonomous Region,China)
出处
《中国实验血液学杂志》
CAS
CSCD
北大核心
2024年第5期1349-1355,共7页
Journal of Experimental Hematology
基金
2023年内蒙古自治区科技计划项目(2023YFSH0036)。
