中华血液学杂志
中華血液學雜誌
중화혈액학잡지
Chinese Journal of Hematology
2013年
7期
561-565
,共5页
耿素霞%翁建宇%黄欣%陆泽生%吴萍%黄励思%刘龙%杜欣
耿素霞%翁建宇%黃訢%陸澤生%吳萍%黃勵思%劉龍%杜訢
경소하%옹건우%황흔%륙택생%오평%황려사%류룡%두흔
白血病,髓系,慢性,BCR-ABL阳性%酪氨酸激酶抑制剂%BCR-ABL转录本%聚合酶链反应%预后
白血病,髓繫,慢性,BCR-ABL暘性%酪氨痠激酶抑製劑%BCR-ABL轉錄本%聚閤酶鏈反應%預後
백혈병,수계,만성,BCR-ABL양성%락안산격매억제제%BCR-ABL전록본%취합매련반응%예후
Leukemia,myelogenous,chronic,BCR-ABL positive%Tyrosine kinase inhibitor%BCR-ABL transcript%Polymerase chain reaction%Prognosis
目的 了解慢性髓性白血病(CML)患者酪氨酸激酶抑制剂(TKI)治疗早期BCR-ABL转录本水平检测的预后价值,为CML患者进行早期预后评估和治疗选择提供依据.方法 通过实时定量PCR方法检测53例CML患者TKI治疗前后不同时间BCR-ABL转录本的水平,分析治疗3个月时BCR-ABL水平与之后获得的分子反应、疾病进展以及突变情况的关系.结果 30例初诊CML患者外周血BCR-ABL转录本水平中位值为43.99％,作为分子反应评价的基线.TKI治疗3个月BCR-ABLmRNA≤4.40％(降低超过1个对数级)31例(58.49％)患者,＞4.40％(降低小于1个对数级)者22例(41.51％),前者治疗18个月获得主要分子学反应(MMR)的比例明显高于后者(90.32％对18.18％,P=0.000);36个月累积完全分子学反应(CMR)的比例前者也明显高于后者(48.39％对0,P=0.000).治疗3个月BCR-ABL水平越低获得MMR越早,但BCR-ABL mRNA＞4.40％组检测到BCR-ABL激酶区突变患者的比例明显高于BCR-ABL mRNA≤4.40％组(22.73％比0,P=0.021),虽然患者疾病进展的比例有增高的趋势,但差异无统计学意义(P=0.052).结论 TKI治疗3个月时BCR-ABL转录本水平对患者的预后评估有重要价值,可能有助于早期优化CML患者的治疗,提高患者的疗效.
目的 瞭解慢性髓性白血病(CML)患者酪氨痠激酶抑製劑(TKI)治療早期BCR-ABL轉錄本水平檢測的預後價值,為CML患者進行早期預後評估和治療選擇提供依據.方法 通過實時定量PCR方法檢測53例CML患者TKI治療前後不同時間BCR-ABL轉錄本的水平,分析治療3箇月時BCR-ABL水平與之後穫得的分子反應、疾病進展以及突變情況的關繫.結果 30例初診CML患者外週血BCR-ABL轉錄本水平中位值為43.99％,作為分子反應評價的基線.TKI治療3箇月BCR-ABLmRNA≤4.40％(降低超過1箇對數級)31例(58.49％)患者,＞4.40％(降低小于1箇對數級)者22例(41.51％),前者治療18箇月穫得主要分子學反應(MMR)的比例明顯高于後者(90.32％對18.18％,P=0.000);36箇月纍積完全分子學反應(CMR)的比例前者也明顯高于後者(48.39％對0,P=0.000).治療3箇月BCR-ABL水平越低穫得MMR越早,但BCR-ABL mRNA＞4.40％組檢測到BCR-ABL激酶區突變患者的比例明顯高于BCR-ABL mRNA≤4.40％組(22.73％比0,P=0.021),雖然患者疾病進展的比例有增高的趨勢,但差異無統計學意義(P=0.052).結論 TKI治療3箇月時BCR-ABL轉錄本水平對患者的預後評估有重要價值,可能有助于早期優化CML患者的治療,提高患者的療效.
목적 료해만성수성백혈병(CML)환자락안산격매억제제(TKI)치료조기BCR-ABL전록본수평검측적예후개치,위CML환자진행조기예후평고화치료선택제공의거.방법 통과실시정량PCR방법검측53례CML환자TKI치료전후불동시간BCR-ABL전록본적수평,분석치료3개월시BCR-ABL수평여지후획득적분자반응、질병진전이급돌변정황적관계.결과 30례초진CML환자외주혈BCR-ABL전록본수평중위치위43.99％,작위분자반응평개적기선.TKI치료3개월BCR-ABLmRNA≤4.40％(강저초과1개대수급)31례(58.49％)환자,＞4.40％(강저소우1개대수급)자22례(41.51％),전자치료18개월획득주요분자학반응(MMR)적비례명현고우후자(90.32％대18.18％,P=0.000);36개월루적완전분자학반응(CMR)적비례전자야명현고우후자(48.39％대0,P=0.000).치료3개월BCR-ABL수평월저획득MMR월조,단BCR-ABL mRNA＞4.40％조검측도BCR-ABL격매구돌변환자적비례명현고우BCR-ABL mRNA≤4.40％조(22.73％비0,P=0.021),수연환자질병진전적비례유증고적추세,단차이무통계학의의(P=0.052).결론 TKI치료3개월시BCR-ABL전록본수평대환자적예후평고유중요개치,가능유조우조기우화CML환자적치료,제고환자적료효.
Objective To understand the predictive value of early monitoring BCR-ABL transcripts in patients with chronic myeloid leukemia (CML) after treatment with tyrosine kinase inhibitor (TKI),and to provides the information for early assessment of prognosis and treatment options.Methods BCR-ABL transcripts of 53 CML patients before and after TKI treatment were detected by using real-time quantitative RT-PCR.The relationship between BCR-ABL transcripts level after TKI treatment for 3 months and the later molecular response,progression and mutation was analyzed.Results The median values of BCR-ABL transcripts in peripheral blood samples from 30 newly diagnosed patients were 43.99％,which was used as a baseline of BCR-ABL transcripts for molecular response evaluation.Of 53 patients,31 (58.49％) had a BCR-ABL mRNA ≤4.40％ (reduced more than 1 log) and 22 (41.51％) greater than 4.40％ (reduced to less than 1 log) after 3 months of TKI treatment.The former 31 patients had a significantly higher 18-months cumulative incidence of major molecular response (MMR) (90.32％vs 18.18％,P=0.000) and 3-year cumulative incidence of complete molecular response (CMR) (48.39％ vs 0,P=0.000) compared with the latter 22 patients.The lower BCR-ABL level was,the earlier MMR reached.The proportion of patients with a mutation in group of BCR-ABL mRNA ＞4.40％ was significantly higher than that of BCR-ABL mRNA ≤4.40％ (22.73％ vs 0,P=0.021).The incidence of progression increased in group of BCR-ABL mRNA ＞4.40％,but the difference was not statistically significant (P=0.052).Conclusions It is important for the prognosis evaluation of the patients to monitor the level of BCR-ABL transcripts at 3 months after TKI treatment,which might help to early optimization of treatment and to improve curative effect of CML patients.
