格列卫在1例慢性粒细胞白血病慢性期患者中的循证应用

目的探讨格列卫在1例慢性粒细胞性白血病慢性期的患者的最佳应用方案.方法计算机检索ACP Journal Club (1991～2005年4月)、Cochrane图书馆(2005年第2期)和MEDLINE(1990～2005年4月),收集格列卫治疗慢性粒细胞白血病慢性期的系统评价、临床随机对照试验、卫生经济学评价等,并对所获证据质量进行评价.结果高质量的临床证据表明:在血液学和细胞遗传学缓解率以及生存质量方面,格列卫均优于传统疗法,且副作用相对较少.结合我们的临床经验,并考虑患者及其家属的意愿,最后为患者制定治疗方案为格列卫400 mg qd,随访3个月血液指标学完全缓解,ph染色体1/30( ),达到主要细胞遗传学缓解,且无明显不良反应发生.结论格列卫是治疗慢性粒细胞性白血病慢性期的有效药物,可作为临床一线用药.但其长期疗效和不良反应以及经济学评价仍有待进一步研究.

Evidence-Based Treatment of a Patient with Chronic-Phase Chronic Myeloid Leukemia by Imatinib

Objective We intended to get good understanding of the current role of imatinib(or glivec) in the treatment of a patient with chronic-phase chronic myeloid leukemia.Methods We attempted to find the current best evidence of imatinib for treating chronic myeloid leukemia in chronic phase by searching ACP Journal Club(1991Jun,2005),The Cochrane Library(Issue 2,2005)and MEDLINE(1990Jun,2005) and further critically appraised the available evidence.Results Imatinib appeared to be more effective than current standard drug treatments in terms of hematologic and cytogenetic response with better quality of life and fewer side effects.However,there was uncertainty concerning long term outcomes.Given the current evidence together with our clinical experience and considering the patient and his family members' values and preference,imatinib(400 mg qd) was administered to him.No obvious adverse effects occurred with 3 months follow-up.Conclusions Imatinib is effective and well tolerated in the treatment of chronic myeloid leukemia in chronic phase.Further researches on long-term follow-up data from imatinib trials are definitely needed.