CAJ | 학술논문

目的探讨甲磺酸伊马替尼(IM)治疗慢性粒细胞白血病(CML)慢性期患者的血液学不良反应发生情况.方法回顾性分析郑州大学附属肿瘤医院2013年1月至2015年1月接受IM治疗的435例CML慢性期患者血液学不良反应的发生情况,比较不同临床病理因素分层患者血液学不良反应的发生率.结果截至随访终点,435例慢性期患者中361例(83.0％)血象正常,74例(17.0％)发生血液学不良反应.61例(14.0％)出现中性粒细胞减少,其中Ⅲ、Ⅳ级9例(14.8％);60例(13.8％)出现血小板减少,其中Ⅲ、Ⅳ级11例(18.3％);50例(11.5％)出现贫血,其中Ⅲ、Ⅳ级5例(10.0％);33例(7.6％)出现全血细胞减少.血液学不良反应多发生于治疗后2～3周.对治疗前病程、脾脏大小、Sokal评分、是否使用干扰素、融合基因、染色体、是否获得完全细胞遗传学缓解、是否获得主要分子学反应、Karnofsky评分9个因素组内患者血液学不良反应发生率进行比较,差异均有统计学意义(均P＜0.05).年龄、性别、体质量指数(BMI)、是否吸烟喝酒4个因素组内患者血液学不良反应发生率比较,差异均无统计学意义(均P＞ 0.05).结论如果IM治疗CML的初期发生Ⅰ、Ⅱ级血液学不良反应,可继续用药,若发生Ⅲ～Ⅳ级血液学不良反应时需减量或停药,患者血象在治疗4～6周后趋于稳定.在IM治疗CML后期出现严重血液学不良反应时,需进行骨髓形态学、分子生物学等相关检查,明确疾病分期,必要时可更换为二代酪氨酸激酶抑制剂.
목적 탐토갑광산이마체니(IM)치료만성립세포백혈병(CML)만성기환자적혈액학불량반응발생정황.방법 회고성분석정주대학부속종류의원2013년1월지2015년1월접수IM치료적435례CML만성기환자혈액학불량반응적발생정황,비교불동림상병리인소분층환자혈액학불량반응적발생솔.결과 절지수방종점,435례만성기환자중361례(83.0％)혈상정상,74례(17.0％)발생혈액학불량반응.61례(14.0％)출현중성립세포감소,기중Ⅲ、Ⅳ급9례(14.8％);60례(13.8％)출현혈소판감소,기중Ⅲ、Ⅳ급11례(18.3％);50례(11.5％)출현빈혈,기중Ⅲ、Ⅳ급5례(10.0％);33례(7.6％)출현전혈세포감소.혈액학불량반응다발생우치료후2～3주.대치료전병정、비장대소、Sokal평분、시부사용간우소、융합기인、염색체、시부획득완전세포유전학완해、시부획득주요분자학반응、Karnofsky평분9개인소조내환자혈액학불량반응발생솔진행비교,차이균유통계학의의(균P＜0.05).년령、성별、체질량지수(BMI)、시부흡연갈주4개인소조내환자혈액학불량반응발생솔비교,차이균무통계학의의(균P＞ 0.05).결론 여과IM치료CML적초기발생Ⅰ、Ⅱ급혈액학불량반응,가계속용약,약발생Ⅲ～Ⅳ급혈액학불량반응시수감량혹정약,환자혈상재치료4～6주후추우은정.재IM치료CML후기출현엄중혈액학불량반응시,수진행골수형태학、분자생물학등상관검사,명학질병분기,필요시가경환위이대락안산격매억제제.
Objective To explore the hematology adverse reactions of imatinib mesylate (IM) in the treatment of chronic phase (CP) of chronic myeloid leukemia (CML).Methods The clinical data of 435 CML-CP patients treated with IM were analyzed respectively in the Affiliated Cancer Hospital of Zhengzhou University from Jan 2013 to Jan 2015.The hematology adverse reactions were followed up regularly and the incidences in different groups with various factors were compared.Results Until the end of follow-up,74 (17.0 ％) patients had hematology adverse reactions.61 (14.02 ％) patients had neutropenia,including 9 (14.75 ％) patients who had level Ⅲ-Ⅳ neutropenia.60 (13.79 ％) cases had thrombocytopenia including 11 (18.33 ％) patients with level Ⅲ-Ⅳ thrombocytopenia.Anemia occurred in 50 (11.49 ％) patients,of whom 5 (10.00 ％) cases were grade Ⅲ-Ⅳ anemia.33 (7.59 ％) cases experienced pancytopenia.The incidence of hematology adverse reactions was influenced by nine factors,including the course before treatment,the size of spleen,Sokal scores,the use of interferon,fusion genes,chromosomes,complete cytogenetic response,main molecular reaction and Karnofsky scores (all P ＜ 0.05),while it was not influenced by age,gender,BMI,smoking and drinking (all P ＞ 0.05).Conclusions During the initial treatment of CML-CP,if patients experienced level Ⅰ-Ⅱ hematology adverse reactions,they can continue to taking IM.However,when level Ⅲ-Ⅳ hematology adverse reactions happened,they need to reduce the dose or stop taking,and one month later,hemocyte will get well.In the long-term treatment of CML,once level Ⅲ-Ⅳ hematology adverse reactions occur,the patients need to receive some related inspections,such as bone marrow morphology and molecular biology detection,to clear the disease stage.When it is necessary,the patients can take the second generation of tyrosine kinase inhibitors.