中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2013年
38期
3035-3039
,共5页
高冠论%许娜%周璇%肖雅娟%丁莉%卢绮思%魏永强%张钰%徐丹
高冠論%許娜%週璇%肖雅娟%丁莉%盧綺思%魏永彊%張鈺%徐丹
고관론%허나%주선%초아연%정리%로기사%위영강%장옥%서단
白血病,髓样,慢性期%造血干细胞移植%伊马替尼%疗效
白血病,髓樣,慢性期%造血榦細胞移植%伊馬替尼%療效
백혈병,수양,만성기%조혈간세포이식%이마체니%료효
Leukemia,myeloid,chronic-phase%Hematopoietic stem cell transplantation%Imatinib%Efficacy
目的 比较甲磺酸伊马替尼和异基因造血干细胞移植治疗慢性髓细胞白血病(CML)慢性期的疗效.方法 选取南方医科大学南方医院血液科2002年2月至2012年12月198例CML慢性期接受甲磺酸伊马替尼或异基因造血干细胞移植治疗的患者,评价两种治疗方法的疗效、生存及疾病进展和不良反应情况.其中甲磺酸伊马替尼组115例,初始剂量400 mg/d,此后依据血象及疗效调整剂量,所有患者每1～3个月复查骨髓细胞学及遗传学1次,以此判断血液学反应和细胞遗传学反应.移植组共83例,移植采用清髓性预处理方案,常规采用甲氨蝶呤加环孢素A进行移植物抗宿主病(GVHD)的预防,部分联合应用麦考酚酸酯和抗胸腺细胞球蛋白,移植后常规检测植活证据、细胞及分子遗传学缓解情况.结果 伊马替尼组86例患者中59例(68.6％)在12个月获得完全细胞遗传学缓解(C CyR),而移植组移植后12个月70例患者中67例(95.7％)获得CCyR.伊马替尼组与移植组累计复发率分别为14.8％ (17/115)、12.3％(10/81).移植组GVHD发生率及感染率较高,而伊马替尼组患者不良反应大多可耐受.患者伊马替尼组10年累计生存率高于移植组(93.9％比77.1％,P=0.015)；10年无疾病进展生存率两组分别为86.1％、88.0％(P=0.508),差异无统计学意义.对于Sokal评分中、高危患者的累计生存率,伊马替尼组均高于移植组(96.4％比68.0％,P=0.049；92.6％比57.1％,P=0.017),而无疾病进展生存率两组差异均无统计学意义(89.3％比88.0％,P=0.942;70.4％比85.7％,P=0.405)；低危患者总生存率与无疾病进展生存率两组差异均无统计学意义.对年龄≥30岁的患者,伊马替尼组累计生存率高于移植组(94.7％比73.5％,P=0.009),而两组无疾病进展生存率分别为84.2％、94.1％ (P =0.147),差异无统计学意义.结论 CML慢性期患者伊马替尼治疗较异基因造血干细胞移植有较好的疗效.
目的 比較甲磺痠伊馬替尼和異基因造血榦細胞移植治療慢性髓細胞白血病(CML)慢性期的療效.方法 選取南方醫科大學南方醫院血液科2002年2月至2012年12月198例CML慢性期接受甲磺痠伊馬替尼或異基因造血榦細胞移植治療的患者,評價兩種治療方法的療效、生存及疾病進展和不良反應情況.其中甲磺痠伊馬替尼組115例,初始劑量400 mg/d,此後依據血象及療效調整劑量,所有患者每1～3箇月複查骨髓細胞學及遺傳學1次,以此判斷血液學反應和細胞遺傳學反應.移植組共83例,移植採用清髓性預處理方案,常規採用甲氨蝶呤加環孢素A進行移植物抗宿主病(GVHD)的預防,部分聯閤應用麥攷酚痠酯和抗胸腺細胞毬蛋白,移植後常規檢測植活證據、細胞及分子遺傳學緩解情況.結果 伊馬替尼組86例患者中59例(68.6％)在12箇月穫得完全細胞遺傳學緩解(C CyR),而移植組移植後12箇月70例患者中67例(95.7％)穫得CCyR.伊馬替尼組與移植組纍計複髮率分彆為14.8％ (17/115)、12.3％(10/81).移植組GVHD髮生率及感染率較高,而伊馬替尼組患者不良反應大多可耐受.患者伊馬替尼組10年纍計生存率高于移植組(93.9％比77.1％,P=0.015)；10年無疾病進展生存率兩組分彆為86.1％、88.0％(P=0.508),差異無統計學意義.對于Sokal評分中、高危患者的纍計生存率,伊馬替尼組均高于移植組(96.4％比68.0％,P=0.049；92.6％比57.1％,P=0.017),而無疾病進展生存率兩組差異均無統計學意義(89.3％比88.0％,P=0.942;70.4％比85.7％,P=0.405)；低危患者總生存率與無疾病進展生存率兩組差異均無統計學意義.對年齡≥30歲的患者,伊馬替尼組纍計生存率高于移植組(94.7％比73.5％,P=0.009),而兩組無疾病進展生存率分彆為84.2％、94.1％ (P =0.147),差異無統計學意義.結論 CML慢性期患者伊馬替尼治療較異基因造血榦細胞移植有較好的療效.
목적 비교갑광산이마체니화이기인조혈간세포이식치료만성수세포백혈병(CML)만성기적료효.방법 선취남방의과대학남방의원혈액과2002년2월지2012년12월198례CML만성기접수갑광산이마체니혹이기인조혈간세포이식치료적환자,평개량충치료방법적료효、생존급질병진전화불량반응정황.기중갑광산이마체니조115례,초시제량400 mg/d,차후의거혈상급료효조정제량,소유환자매1～3개월복사골수세포학급유전학1차,이차판단혈액학반응화세포유전학반응.이식조공83례,이식채용청수성예처리방안,상규채용갑안접령가배포소A진행이식물항숙주병(GVHD)적예방,부분연합응용맥고분산지화항흉선세포구단백,이식후상규검측식활증거、세포급분자유전학완해정황.결과 이마체니조86례환자중59례(68.6％)재12개월획득완전세포유전학완해(C CyR),이이식조이식후12개월70례환자중67례(95.7％)획득CCyR.이마체니조여이식조루계복발솔분별위14.8％ (17/115)、12.3％(10/81).이식조GVHD발생솔급감염솔교고,이이마체니조환자불량반응대다가내수.환자이마체니조10년루계생존솔고우이식조(93.9％비77.1％,P=0.015)；10년무질병진전생존솔량조분별위86.1％、88.0％(P=0.508),차이무통계학의의.대우Sokal평분중、고위환자적루계생존솔,이마체니조균고우이식조(96.4％비68.0％,P=0.049；92.6％비57.1％,P=0.017),이무질병진전생존솔량조차이균무통계학의의(89.3％비88.0％,P=0.942;70.4％비85.7％,P=0.405)；저위환자총생존솔여무질병진전생존솔량조차이균무통계학의의.대년령≥30세적환자,이마체니조루계생존솔고우이식조(94.7％비73.5％,P=0.009),이량조무질병진전생존솔분별위84.2％、94.1％ (P =0.147),차이무통계학의의.결론 CML만성기환자이마체니치료교이기인조혈간세포이식유교호적료효.
Objective To compare the treatment efficacy of imatinib mesylate versus allogeneic hematopoietic stem cell transplantation (allo-HSCT) for patients with chronic myeloid leukemia in chronic phase.Methods The efficacy,overall survival,progression-free survival and adverse events were evaluated in 198 patients on these two therapies from February 2002 to December 2012 at our hospital.One hundred and fifteen cases in imatinib group (n =115) received imatinib at an initial daily dose of 400 mg and then dose was adjusted according to blood routine test and therapy response.All patients were evaluated for hematologic,cytogenetic and molecular responses every 1-3 months.The allo-HSCT group (n =83) received myeloablative preconditioning regimen and methotrexate (MTX) and cyclosporine A (CsA) were used for graft-versus-host disease (GVHD) partially plus mycophenolate mofetil (MMF) and antihuman thymocyte globulin (ATG).The engraftment evidence and evolution of cytogenetic and molecular response was conventionally detected after allo-HSCT.Results In imatinib group,59 of 86 (68.6％) cases achieved complete cytogenetic response (CCyR) in the 12 months after therapy,while 67 of 70 (95.7％) cases achieved CCyR in allo-HSCT group.The relapse rates of two groups were 14.8％ (17/115),12.3％(10/81) respectively.The adverse reaction of imatinib in imatinib group was obviously much more tolerable for patients compared with frequently occurred GVHD and infection in allo-HSCT group.The 10-year cumulative overall survival (OS) rate was 93.9％ in imatinib group and 77.1％ in allo-HSCT group (P =0.015).And the 10-year cumulative progression-free survival (PFS) rate was 86.1％ in imatinib group versus 88.0％ in allo-HSCT group(P =0.508).For Sokal rating stratified analysis,the cumulative OS rates of two groups were 96.4％ and 68.0％ (P =0.049) for intermediate-risk patients,92.6％ and 57.1％ (P =0.017) for high-risk patients while the cumulative PFS rates of two groups were 89.3％ and 88.0％ for intermediate-risk patients (P =0.942),70.4％ and 85.7％ for high-risk patients (P =0.405).The rates of OS and PFS were not significantly different for low-risk patients.The cumulative OS rates of two groups were 94.7％ and 73.5％ (P =0.009) for those ≥ 30 years old and the cumulative PFS rates of two groups 84.2％ and 94.1％ respectively (P =0.147).Conclusion Imatinib mesylate is superior to allo-HSCT for patients with chronic myeloid leukemia in chronic phase.
