Rousselot Philippe, Huguet Francoise, Rea Delphine, Legros Laurence, Cayuela Jean Michel, Maarek Odile, Blanchet Odile, Marit Gerald, Gluckman Eliane, Reiffers Josy, Gardembas Martine, Mahon François-Xavier
Fédération d'hématologie et Centre d'Investigation Clinique, Hôpital Saint-Louis, Paris, France.
Blood. 2007 Jan 1;109(1):58-60. doi: 10.1182/blood-2006-03-011239. Epub 2006 Sep 14.
In the present study, we address the issue of the discontinuation of imatinib mesylate (Gleevec) in chronic myelogenous leukemia with undetectable residual disease for more than 2 years. Twelve patients were included. The median duration of real-time quantitative-polymerase chain reaction (RTQ-PCR) negativity and imatinib therapy were, respectively, 32 months (range, 24-46 months) and 45 months (range, 32-56 months) before imatinib interruption. Six patients displayed a molecular relapse with a detectable BCR-ABL transcript at 1, 1, 2, 3, 4, and 5 months. Imatinib was then reintroduced and led to a novel molecular response in most patients. Six other patients (50%) still have an undetectable level of BCR-ABL transcript after a median follow-up of 18 months (range, 9-24 months). We hypothesize that relapses observed within 6 months reflect the kinetics of undetectable dividing chronic myelogenous leukemia (CML) cells. Those cells may be eradicated or controlled in long-term nonrelapsing patients, as described in our study.
在本研究中，我们探讨了慢性粒细胞白血病患者在残留疾病检测不到超过2年的情况下停用甲磺酸伊马替尼（格列卫）的问题。纳入了12例患者。在伊马替尼中断前，实时定量聚合酶链反应（RTQ-PCR）阴性的中位持续时间和伊马替尼治疗的中位持续时间分别为32个月（范围24 - 46个月）和45个月（范围32 - 56个月）。6例患者在1、1、2、3、4和5个月时出现分子复发，可检测到BCR-ABL转录本。然后重新引入伊马替尼，大多数患者出现了新的分子反应。在中位随访18个月（范围9 - 24个月）后，其他6例患者（50%）的BCR-ABL转录本水平仍检测不到。我们推测，在6个月内观察到的复发反映了检测不到的分裂慢性粒细胞白血病（CML）细胞的动力学。如我们的研究所描述，这些细胞可能在长期未复发的患者中被根除或得到控制。
