摘要
目的:探讨第一代酪氨酸激酶抑制剂(TKI)伊马替尼治疗初治慢性髓系白血病慢性期(CML-CP)患者疗效差(疗效欠佳、失败或不耐受)时换用第2代TKI的时机及疗效。方法:观察2009年2月至2012年2月间9例初治CM L-CP患者应用伊马替尼后(3例不耐受,6例治疗失败或欠佳)换用第Ⅱ代TKI治疗的效果及副作用。结果:3例不耐受患者换第2代TKI后均获得了满意的疗效,均在换用3个月达到完全细胞遗传学缓解(CCyR),分别在3至6个月达到主要分子生物学缓解(MMR),疗效均达到欧洲白血病网(ELN)指南的疗效满意标准,但有1例患者在用药3个月后出现胸水而暂时停药,仍持续缓解。6例疗效不理想患者中2例经伊马替尼治疗失败的患者换用第2代后仍疾病进展,其中1例有效但耐受性差,进展至加速期后进行了单倍体造血干细胞移植获治愈;1例治疗失败,发生急变,在化疗后因严重感染去世;另4例疗效欠佳患者均在换用第2代TKI后3-12个月内达到了MMR,疗效满意,已分别持续CMR 12-36月。结论:CML-CP患者在伊马替尼疗效不满意时应尽早换用第2代TKI治疗,而且越早越受益,有可能获得最佳疗效。
Objective： This study was to investigate the timing and clinical efficacy of switching to the 2nd generation of tyrosine kinase inhibitor （TKI） for CML patients at poor response to imatinib （ dissatifed efficacy or intolerance）. Methods：The therapeatic efficacy and side reaction of switched 2nd TKI in patients with newly diagnsed CML-CP who poorly responded to imatinib were observed, anong them 3 cases were intolerant, 6 cases did not acquire satisfied efficacy. Results： After switching to 2nd generation TKI, 3 patients with intolerance achieved complete cytogenetic remission （CCyR） in 3 months, and major molecular remission （MMR） in 3 - 6 months. All of them achieved optimal efficacy according to European Leukemia Network （ELN）, but the pleural effusion appeared in 1 case after use of 2nd generation of TKI for 3 months, and the dadatinib was stoped temporally, and the curative efficacy still was maintained. Among 6 cases with poor efficacy by treatment with imatinib, 2 cases with BCR/ABL mutation progressed after switching 2nd generation of TKI, out of them 1 case with poor tolerance progeressed to the accelerated phase, but was cured by haploidentical allogeneic hematopoictic stem cell transplantation, 1 case progressed to blastic crisis and died of serious infection; the another 4 cases achieved MMR in 3 - 12 months after using 2nd generation of TKI, and maintained CMR for 12 -36 months. Conclusion：CML-CP patients without the optimal response to imatinib should be treated by switching to 2nd generation of TKI as soon as possible, and thereby patients may acquired satisfactory theralaentic efficacy.
出处
《中国实验血液学杂志》
CAS
CSCD
北大核心
2015年第1期65-69,共5页
Journal of Experimental Hematology
基金
首都临床特色应用研究(Z121107001012082)
