CAJ | 학술논문

目的观察酪氨酸激酶抑制剂治疗后慢性髓细胞白血病(chronic myelogenous leukemia,CML)Ph阴性细胞中染色体异常(chromosomal abnormalities in Ph negative cells,Ph- CAs)的遗传学特征和转归.方法对15例接受酪氨酸激酶抑制剂治疗后出现Ph- CAs的CML患者进行遗传学和分子学动态观察.结果出现Ph- CAs患者中,依马替尼治疗12例,达沙替尼治疗2例,伯舒替尼治疗1例,染色体异常以+8最为多见,占46.7％.Ph- CAs出现在ph+克隆减少或消失时,出现的平均时间为11.1个月(1～28个月)；7例Ph- CAs已经消失,Ph- CAs持续的平均时间为10.9个月(3～24个月).Ph- CAs出现时,所有病例均未见骨髓病态造血或急性白血病；Ph- CAs出现后,除1例患者演变为ph+急性单核细胞白血病外,其余均获得骨髓缓解,11例获完全细胞遗传学反应,4例获完全分子学反应.结论依马替尼、达沙替尼和伯舒替尼治疗CML患者均可能出现Ph- CAs；Ph- CAs多数为一过性,对酪氨酸激酶抑制剂治疗效果无影响.
목적 관찰락안산격매억제제치료후만성수세포백혈병(chronic myelogenous leukemia,CML)Ph음성세포중염색체이상(chromosomal abnormalities in Ph negative cells,Ph- CAs)적유전학특정화전귀.방법 대15례접수락안산격매억제제치료후출현Ph- CAs적CML환자진행유전학화분자학동태관찰.결과 출현Ph- CAs환자중,의마체니치료12례,체사체니치료2례,백서체니치료1례,염색체이상이+8최위다견,점46.7％.Ph- CAs출현재ph+극륭감소혹소실시,출현적평균시간위11.1개월(1～28개월)；7례Ph- CAs이경소실,Ph- CAs지속적평균시간위10.9개월(3～24개월).Ph- CAs출현시,소유병례균미견골수병태조혈혹급성백혈병；Ph- CAs출현후,제1례환자연변위ph+급성단핵세포백혈병외,기여균획득골수완해,11례획완전세포유전학반응,4례획완전분자학반응.결론 의마체니、체사체니화백서체니치료CML환자균가능출현Ph- CAs；Ph- CAs다수위일과성,대락안산격매억제제치료효과무영향.
Objective To investigate cytogenetic features and outcome of chromosomal abnormalities in Philadelphia negative cells (Ph-CAs) of chronic myelogenous leukemia (CML) patients treated with tyrosine kinase inhibitors.Methods Clinical and laboratory data of 15 CML patients in which Ph- CAs occurred after tyrosine kinase inhibitors therapy were collected and analyzed.Results Of 15 cases with Ph-CAs,12 patients were treated with imatinib,2 were treated with dasatinib and 1 was treated with bosutinib.+8 was the most common abnormality in Ph- CAs,which accounted for 46.7％ of all.Ph CAs usually occurred when Ph+ cells decreased or disappeared due to tyrosine kinase inhibitors therapy.The average time for the appearance of Ph-CAs was 11.1 months (1-28 months).In 7 patients,the Ph-CAs have disappeared in 10.9 months (3-24 months). In such patients,no myelodysplastic syndrome or acute leukemia was observed. One patient has progressed to acute monocytic leukemia with Ph+ cells. All remaining patients have achieved bone morrow remission,among which 11 patients achieved complete cytogenic response and 4 patients even achieved complete molecular response.Conclusion The majority of Ph-CAs developed in CML patients are transient in nature.They may develop following imatinib,dasatinib or bosutinib therapy but do not interfere with the therapeutic effects of tyrosine kinase inhibitors.