Cortes Jorge E, Talpaz Moshe, O'Brien Susan, Faderl Stefan, Garcia-Manero Guillermo, Ferrajoli Alessandra, Verstovsek Srdan, Rios Mary B, Shan Jenny, Kantarjian Hagop M
Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
Cancer. 2006 Mar 15;106(6):1306-15. doi: 10.1002/cncr.21756.
Several staging classification systems, all of which were designed in the preimatinib era, are used for chronic myeloid leukemia (CML). The World Health Organization (WHO) recently proposed a new classification system that has not been validated clinically. The authors investigated the significance of the WHO classification system and compared it with the classification systems used to date in imatinib trials ("standard definition") to determine its impact in establishing the outcome of patients after therapy with imatinib.
In total, 809 patients who received imatinib for CML were classified into chronic phase (CP), accelerated phase (AP), and blast phase (BP) based on standard definitions and then were reclassified according to the new WHO classification system. Their outcomes with imatinib therapy were compared, and the value of individual components of these classification systems was determined.
With the WHO classification, 78 patients (10%) were reclassified: 45 patients (6%) were reclassified from CP to AP, 14 patients (2%) were reclassified from AP to CP, and 19 patients (2%) were reclassified from AP to BP. The rates of complete cytogenetic response for patients in CP, AP, and BP according to the standard definition were 72%, 45%, and 8%, respectively. After these patients were reclassified according to WHO criteria, the response rates were 77% (P = 0.07), 39% (P = 0.28), and 11% (P = 0.61), respectively. The 3-year survival rates were 91%, 65%, and 10%, respectively, according to the standard classification and 95% (P = 0.05), 63% (P = 0.76), and 16% (P = 0.18), respectively, according to the WHO classification. Patients who had a blast percentage of 20-29%, which is considered CML-BP according to the WHO classification, had a significantly better response rate (21% vs. 8%; P = 0.11) and 3-year survival rate (42% vs. 10%; P = 0.0001) compared with patients who had blasts > or = 30%.
Different classification systems had an impact on the outcome of patients, and some prognostic features had different prognostic implications in the imatinib era. The authors believe that a new, uniform staging system for CML is warranted, and they propose such a system.
几种分期分类系统都用于慢性髓性白血病（CML），且均设计于伊马替尼时代之前。世界卫生组织（WHO）最近提出了一种尚未经过临床验证的新分类系统。作者研究了WHO分类系统的意义，并将其与伊马替尼试验中使用的分类系统（“标准定义”）进行比较，以确定其对伊马替尼治疗后患者预后评估的影响。
总共809例接受伊马替尼治疗的CML患者根据标准定义分为慢性期（CP）、加速期（AP）和急变期（BP），然后根据WHO新分类系统重新分类。比较他们接受伊马替尼治疗的预后，并确定这些分类系统各个组成部分的价值。
按照WHO分类，78例患者（10%）被重新分类：45例患者（6%）从CP重新分类为AP，14例患者（2%）从AP重新分类为CP，19例患者（2%）从AP重新分类为BP。根据标准定义，CP、AP和BP患者的完全细胞遗传学缓解率分别为72%、45%和8%。这些患者按照WHO标准重新分类后，缓解率分别为77%（P = 0.07）、39%（P = 0.28）和11%（P = 0.61）。根据标准分类，3年生存率分别为91%、65%和10%，而根据WHO分类分别为95%（P = 0.05）、63%（P = 0.76）和16%（P = 0.18）。WHO分类中原始细胞百分比为20% - 29%的患者（被视为CML - BP），与原始细胞≥30%的患者相比，缓解率（21%对8%；P = 0.11）和3年生存率（42%对10%；P = 0.0001）显著更好。
不同的分类系统对患者预后有影响，且在伊马替尼时代一些预后特征具有不同的预后意义。作者认为有必要为CML建立一个新的统一分期系统，并提出了这样一个系统。
