伊马替尼治疗Ph阳性进展期慢性粒细胞白血病

目的:观察伊马替尼治疗Ph阳性进展期慢性粒细胞白血病(CML)的疗效和耐药情况,研究改善伊马替尼耐药的方法。方法:32例Ph阳性进展期CML病人,其中加速期12例,急变期20例,每日口服伊马替尼600或800mg,持续3～9mo。结果:CML加速期病人血液学完全缓解率和总有效率分别为42%和83%,主要细胞遗传学缓解率25%,持续完全血液学缓解病例占25%。CML急变期各类型病人血液学完全缓解率和总有效率分别为20%和55%,主要细胞遗传学缓解率15%,持续完全血液学缓解病例占10%。CML急变期原发耐药和继发耐药分别为45%和20%,联合化疗与暂停伊马替尼对继发耐药可暂时改善其耐药性,但药物有效时间明显缩短。结论:伊马替尼对初治或复治的CML加速期和急变期病人均有效,可作为非移植CML治疗的标准一线方案,伊马替尼治疗CML急变期的原发耐药和继发耐药率较高,联合化疗和暂停伊马替尼可暂时改善其耐药性。

Imatinib in treatment of advanced stage chromosome positive chronic myelocytic leukemia

AIM: To assess the therapeutic effect and resistance of imat inib in patients with chromosome positive chronic myelocytic leukemia(CML) in advanced s tage, and to find out the methods of improving the resistance of imatinib. METHODS: Thirty-two patients with Ph( ) CML in advanced stage; 12 patients in accelerated phase, 20 patients in blastic phase, received oral administration of imatinib 600 mg or 800 mg once daily for 3-9 mo, respectively. RESULTS: The complete hematological remission (C HR) rate and the total effective rate in patients during accelerated phase were 42 % and 83 %, respectively, and furthermore the major cytogenetic remission (MC R) rate and persisting CHR rate were 25 % and 25 % respectively. The CHR rate and th e total effective rate in patients during blastic phase were 20 % and 55 %, resp ec tively, and furthermore the MCR rate and persisting CHR rate were 15 % and 10 % re spectively. The primary resistance and secondary resistance of imatinib for blas tic phase were 45 % and 20 %, respectively. The resistance was temporarily decre as e d by combined chemotherapy and temporary stoppage of imatinib therapy. CONCLUSION: Imatinib can be used as first-line standard agents for non-transplantation t reatment of CML which is effective to patients with CML in accelerated phase and blastic phase. The drug resistance rate of imatinib for patients with CML in b lastic phase is high. The drug resistance can be temporarily decreased by combi ned chemotherapy and stopping imatinib therapy.