伊马替尼治疗慢性粒细胞性白血病患者的疗效分析

目的：评估伊马替尼治疗慢性粒细胞性白血病（CML）临床疗效及不良反应，为选择CML的最佳治疗方案提供依据。方法：选取明确诊断为CML的患者239例，根据患者接受治疗情况分为CML慢性期（CP）患者伊马替尼治疗组(55例)、CML加速期（AP）和急变期（BP）患者伊马替尼治疗组（30例）及CML慢性期患者化疗和/或干扰素治疗组（154例）。监测各组患者接受治疗后、完全血液学缓解(CHR)、完全细胞遗传学缓解(CCR)、主要分子学缓解情况(MMR)及不良反应的发生情况。监测伊马替尼耐药患者的血药浓度水平、染色体及基因突变情况。结果：CML CP伊马替尼治疗组中，CP早期（诊断1年内开始治疗，CP＜1年）患者46例，接受治疗3个月CHR达100%；12个月CCR达83%；18个月MMR达30%；CP晚期（诊断超过1年开始治疗，CP>1年）　患者9例，其CHR、CCR和MMR分别为88%、30%和22%。CML AP和BP伊马替尼治疗组中，AP患者12例，CHR、CCR及MMR分别50%、25%和17%。BP患者18例，22.0%的患者达CHR，16.7%的患者达CCR，无MMR病例。CML CP化疗和/或干扰素治疗组患者154例，CHR达47.4%，CCR及MMR均为0%。CP患者CHR、CCR和MMR与CP化疗和/或干扰素治疗组比较差异有统计学意义(P<0.05)。伊马替尼治疗组中共有14例患者出现伊马替尼耐药，其中CP患者4例（4/55），AP患者3例（3/12），BP患者7例(7/18)。2例　CP患者在监测中发现血药浓度下降。5例耐药患者检出复杂染色体核型，其中CP患者2例，AP患者2例，BP患者1例。4例耐药患者监测到基因突变。结论：伊马替尼治疗CML CP患者在血液学、细胞遗传学和分子学缓解等方面明显优于化疗和/或干扰素治疗。伊马替尼治疗CP患者疗效优于AP及BP患者，CP早期患者接受伊马替尼治疗，缓解情况优于CP晚期患者。
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Efficacy analysis of imatinib in treatment of patients with chronic myeloid leukemia

Objective To assess the efficacy and adverse reactions of imatinib in the treatment of patients with chronic myeloid leukemia(CML),and to provide the basis for choosing the best treatment program.Methods 239 patients diagnosed as CML were divided into three groups,55 patients in CML chronic phase(CP) CML group were treated with imatinib,30 patients in the accelerated phase(AP) and blastic phase(BP) group were treated with imatinib and 154 patients in CML CP chemotherapy and/or interferon group were treated with chemotherapy and/or interferon.The clinical symptoms after treatment,such as the complete hematologic remission(CHR),the complete cytogenetic remission(CCR),the major molecular remission(MMR) and the side effects were analyzed.The plasma concentration,the chromosome and the mutation of the imatinib-resistant patients were deteced.Results 46 patients in CP CML group were in the early CP(the patients were treated within 1 year after diagnosis,CP <1 year).100% of the patients in this group achieved CHR in 3 months,and 83% of the patients achieved CCR in 12 months,and 30% of the patients achieved MMR in 18 months.There were 9 patients in the late CP(the patients were treated more than 1 year after the diagnosis,CP> 1 year),the CHR rate was 88%,and the CCR rate was 30%,and the MMR rate was 22%.In AP and BL CML group,there were 12 AP CML patients,50% of the patients in this group achieved CHR,and 25% of the patients achieved CCR,and 17% of the patients achieved MMR;there were 18 BP CML patients,22% of the patients achieved CHR,and 16.7% achieved CCR,and no patient achieved MMR.In CP CML chemotherapy and/or interferon group,the CHR rate was 47.4%,and both the CCR and the MMR rates were 0%.The CHR,CCR and MMR of the patients in CP CML group were higher than those in CP CML chemotherapy and/or interferon group(P<0.05).14 patients in imatinib groups were imatinib-resistant.The drug concentrations of 2 imatinib-resistant patients were tested to be declined.5 imatinib-resistant patients had complex karyotypes(including 2 CP patients,2 AP patients and 1 BP patients).The gene mutations were tested in 4 imatinib-resistant patients.Conclusion Compared with CP CML chemotherapy and/or interferon group,the patients in imatinib groups could achieve a higher hematologic,cytogenetic and molecular remission rate.The patients in CP CML group treated with imatinb achieve a higher remission rate than AP and BP CML group.The remission rate of the patients in early CP group is higher than that in late CP group.