%0 Journal Article
%T 伊马替尼治疗新诊断与重组人干扰素α2b治疗失败的慢性髓性白血病患者疗效比较
%A 江锦红
%A 徐伟来
%A 钱文斌
%J 浙江大学学报(医学版)
%D 2015
%R 10.3785/j.issn.1008-9292.2015.03.010
%X 目的:回顾性分析和比较伊马替尼治疗新诊断和重组人干扰素α2b(以下简称干扰素)治疗失败的慢性髓性白血病患者的疗效。方法:收集86例应用伊马替尼(每天400mg)治疗的慢性髓性白血病患者的临床资料,其中新诊断患者61例,干扰素治疗失败患者25例;采用R显带技术和实时定量PCR检测细胞遗传学和BCR-ABL融合基因进行疗效分析比较。结果:新诊断组和干扰素治疗失败组治疗6个月时就获得部分细胞遗传学缓解的患者分别为50/61(81.9%)和9/25(36.0%);两组获得完全细胞遗传学缓解的患者分别为53/61例(86.9%)和17/25例(68.0%),差异有统计学意义(P<0.001);两组患者达到完全细胞遗传学缓解的中位时间分别为10个月(3～34个月)和5个月(1～17个月),差异有统计学意义(P=0.001)。新诊断组和干扰素治疗失败组获得完全分子生物学反应分别为43/61(70.4%)和10/25(40.0%),差异有统计学意义(P=0.033)。两组患者中有28例是细胞遗传学耐药,新诊断组为14例(22.9%),其中原发性细胞遗传学耐药4例;干扰素治疗失败组为14例(56.0%),均为原发性细胞遗传学耐药。结论:干扰素治疗失败的慢性髓性白血病患者应用伊马替尼治疗,其原发耐药发生率高,治疗6个月和12个月获得最佳反应的患者比例低;提示这些患者应适时更换第二代酪氨酸激酶抑制剂治疗。</br>Abstract: Objective: To evaluate the efficacy of imatinib mesylate (IM) for patients with newly diagnosed chronic myeloid leukemia (CML) and patients after failure of Recombinant Human interferon-α2b (IFN-α2b) therapy. Methods: A total of 86 patients with CML in chronic-phase, including 61 newly diagnosed cases and 25 cases of IFN-α2b failure, who received IM at 400 mg daily were retrospectively analyzed. Conventional cytogenetic analysis of R-banding was used to detect chromosome abnormalities and real-time PCR was used to detect BCR-ABL fusion gene.Results: 81.9% of newly diagnosed patients and 36.0% of IFN-α2b failure patients achieved partial cytogenetic response (PCyR) by 6 months. In addition, 86.9% of newly diagnosed patients and 68.0% of IFN-α2b failure patients achieved complete cytogenetic response (CCyR) in 24 months. There was significant difference between two groups (P<0.001). The median time achieved CCyR in newly diagnosed group and IFN-α2b failure group were 6 months and 15 months, respectively. Compared with newly diagnosed group, IFN-α2b failure group showed lower rate of complete molecular remission (CMR) (70.4%vs 40.0%, P=0.033). There are 14 patients (22.9%) in newly diagnosed patients with cytogenetic resistance, among whom 4 with primary cytogenetic resistance; while there were 14 patients (56.0%) in IFN-α2b failure group with cytogenetic resistance, all of whom with primary resistance. Conclusion: Compared with newly diagnosed patients, CML patients after failure of IFN-α2b therapy have a high rate of primary cytogenetic resistance and low response rate to IM. Key words: Leukemia, myelogenous, chronic, BCR-ABL positive/drug therapy Piperazines/therapeutic use Pyrimidines/therapeutic use Interferons/therapeutic use Fusion proteins, BCR-ABL/therapeutic use Treatment outcome Philadelphia chromosome
%K Leukemia
%K myelogenous
%K chronic
%K BCR-ABL positive/drug therapy Piperazines/therapeutic use Pyrimidines/therapeutic use Interferons/therapeutic use Fusion proteins
%K BCR-ABL/therapeutic use Treatment outcome Philadelphia chromosome
%U http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2015.03.010