CAJ | 학술논문

目的：观察酪氨酸激酶抑制剂联合化疗治疗 Ph 阳性急性淋巴细胞白血病的疗效及毒副反应。方法回顾性分析41例成人初治 Ph 阳性急性淋巴细胞白血病的治疗资料，比较观察应用酪氨酸激酶抑制剂联合化疗方案的联合组（21例）及单纯应用化疗方案的单纯化疗组（20例）的缓解率、缓解持续时间、中位生存期、生存率、粒细胞缺乏时间、出血率、感染率等指标。结果联合组和单纯化疗组的诱导缓解率分别为85.7%和55.0%（P ＝0.030）；平均缓解时间分别为10.3个月和6.5个月（P ＝0.020）；联合组和单纯化疗组的中位生存期分别为12.0个月和10.0个月，累积半年生存率分别为95.2%和75.0%，1 a 生存率分别47.6%和20.0%（P ＝0.009）。2组均出现Ⅳ度骨髓抑制，2组化疗后中性粒细胞缺乏持续时间比较差异均无统计学意义（P ＝0.196）；2组继发出血率52.4%和45.0%（P ＝0.880）、感染率61.9%和55.0%（P ＝0.650）等非血液学毒性发生率差异均无统计学意义。结论酪氨酸激酶抑制剂联合化疗能够更好地缓解Ph 阳性急性淋巴细胞白血病患者病情，延长患者生存期，且毒副反应未见明显增加。
목적：관찰락안산격매억제제연합화료치료 Ph 양성급성림파세포백혈병적료효급독부반응。방법회고성분석41례성인초치 Ph 양성급성림파세포백혈병적치료자료，비교관찰응용락안산격매억제제연합화료방안적연합조（21례）급단순응용화료방안적단순화료조（20례）적완해솔、완해지속시간、중위생존기、생존솔、립세포결핍시간、출혈솔、감염솔등지표。결과연합조화단순화료조적유도완해솔분별위85.7%화55.0%（P ＝0.030）；평균완해시간분별위10.3개월화6.5개월（P ＝0.020）；연합조화단순화료조적중위생존기분별위12.0개월화10.0개월，루적반년생존솔분별위95.2%화75.0%，1 a 생존솔분별47.6%화20.0%（P ＝0.009）。2조균출현Ⅳ도골수억제，2조화료후중성립세포결핍지속시간비교차이균무통계학의의（P ＝0.196）；2조계발출혈솔52.4%화45.0%（P ＝0.880）、감염솔61.9%화55.0%（P ＝0.650）등비혈액학독성발생솔차이균무통계학의의。결론락안산격매억제제연합화료능구경호지완해Ph 양성급성림파세포백혈병환자병정，연장환자생존기，차독부반응미견명현증가。
Objective To investigate the curative effect and toxicities of tyrosine kinase inhibitor combined with chemotherapy in the treatment of Ph positive acute lymphoblastic leukemia. Methods The treatment data of the 41 cases of adult with Ph positive acute lymphoblastic leukemia were analyzed retrospectively. Twenty-one cases were treated by tyrosine kinase inhibitors combined with chemotherapy,twenty cases were treated by the single chemother-apy. The response rate,relieve duration,median survival,survival rate,granulocyte lack time,bleeding rate,infection rate and other indicators were compared between the two groups. Results The induced remission rate was 85. 7%in the combination group,and was 55. 0% in the pure chemotherapy group(P = 0. 030). The average alleviate time were 10. 3 months and 6. 5 months respectively(P = 0. 020). The median survival time were 12. 0 months and 10. 0 months respectively,the cumulative half year survival rate were 95. 2% and 75. 0% respectively,and 1-year survival rates were 47. 6% and 20. 0% respectively(P = 0. 009). bone marrow suppression with grade Ⅳ was observed in the two groups,neutrophils lack duration had no statistical difference between the two groups after chemotherapy(P= 0. 196). The secondary hemorrhage rate of the two groups were 52. 4% and 45. 0% respectively(P = 0. 880), the infection rates were 61. 9% and 55. 0% respectively(P = 0. 650). Conclusion Tyrosine kinase inhibitor com-bined with chemotherapy can significantly improve the response rate of Ph positive acute lymphoblastic leukemia, improve the survival,and the toxicities can be tolerated.