Wang Jian-Xiang, Huang Xiao-Jun, Wu De-Pei, Hu Jian-da, Liu Ting, Hu Yu, Meng Fan-Yi, Chen Xie-Qun, Hou Ming, Li Yan, Wang Shu-Jie, Wang Jian-Min, Ren Han-Yun, Yu Li, Chen Fang-Yuan, Qiu Lu-Gui, Jiang Bin, Sun Ai-Ning, Liu Ting-Bo, Zhu Huan-Ling, Guo Tao, Xu Dan, Ji Chun-Yan, Lü Xiao-Yi, Jiao Li, Song Xian-Min, Huang Hong-Hui
Institute of Hematology and Blood Diseases Hospital, CAMS and PUMC, Tianjin 300020, China.
Zhonghua Xue Ye Xue Za Zhi. 2009 Nov;30(11):721-5.
To explore demographic characteristics, current diagnosis and treatment patterns of chronic myelogenous leukemia (CML) patients in China.
Data of hospitalized CML patients in 2005 whole year and outpatient information (July 1 through September 30, 2006) from 15 hospitals throughout China were analyzed.
A total of 1824 CML cases were analyzed, including 722 inpatients and 1102 outpatients. The male/female ratio was 1.78:1. The median age at diagnosis was 40.02 (2.45 - 83.29) years old, 90.41% of the patients were diagnosed at chronic phase. Proportion of accelerated phase or blast crisis patients increased to 21.66% during study period. 93.20% of the patients received blood routine and bone marrow morphologic examination at diagnosis and in monitoring; 70.29% were performed cytogenetic analysis and 51.54% performed molecular measurement in addition. The most common therapy for CML treatment was hydroxycarbamide. The proportion of patients treated with imatinib and interferon was 37.45% and 25.55%, respectively. Of 722 inpatients, 164 (22.72%) received hemotopoietic stem cell transplantation (HSCT). The proportions of accelerated phase and blast crisis patients treated with imatinib were 48.28% and 48.42%, respectively, being significantly higher than that of chronic phase patients (35.9%) (P < 0.05). The mean imatinib dosage administered in the three phases patients did not differ significantly. Imatinib resistance rates were 6.87% and 16.28% for outpatient and inpatient, respectively. In the outpatient group, the primary resistance to imatinib occurred comparably to the secondary resistance (68.75%), while primary resistance was predominant in inpatient group (65.71%). The intolerance rates of imatinib for outpatient and inpatient were 3.21%, 11.63%, respectively. The majority of patients treated with imatinb were not monitored in time: 63.38% patients evaluated hematologic response after 3 months of treatment, proportions of patients received cytogenetic examination after 6 months and 12 months of treatment were 41.41% and 27.35%, respectively. Mean cost for HSCT was 213 092 +/- 125 890 RMB.
CML in China tends to afflict younger population than in Western countries. Most patients were diagnosed in the chronic phase. Due to restriction of financial support, only one third of CML patients were treated with imatinib, and the majority of the treated were not monitored in time. Clinicians should pay attention to resistance and intolerance to imatinib treatment in accelerated phase or blast crisis patients.
探讨中国慢性髓性白血病（CML）患者的人口统计学特征、当前诊断及治疗模式。
分析了2005年全年中国15家医院住院CML患者的数据以及2006年7月1日至9月30日的门诊信息。
共分析了1824例CML病例，其中住院患者722例，门诊患者1102例。男女比例为1.78∶1。诊断时的中位年龄为40.02（2.45 - 83.29）岁，90.41%的患者在慢性期被诊断。在研究期间，加速期或急变期患者的比例增至21.66%。93.20%的患者在诊断及监测时接受了血常规和骨髓形态学检查；另外70.29%的患者进行了细胞遗传学分析，51.54%的患者进行了分子检测。CML治疗最常用的疗法是羟基脲。接受伊马替尼和干扰素治疗的患者比例分别为37.45%和25.55%。在722例住院患者中，164例（22.72%）接受了造血干细胞移植（HSCT）。加速期和急变期接受伊马替尼治疗的患者比例分别为 48.28%和48.42%，显著高于慢性期患者（35.9%）（P < 0.05）。三个分期患者的伊马替尼平均给药剂量无显著差异。门诊患者和住院患者的伊马替尼耐药率分别为6.87%和16.28%。在门诊组中，伊马替尼原发耐药与继发耐药的发生率相近（68.75%），而在住院组中原发耐药占主导（65.71%）。门诊患者和住院患者对伊马替尼的不耐受率分别为3.21%、11.63%。大多数接受伊马替尼治疗的患者未得到及时监测：63.38%的患者在治疗3个月后评估血液学反应，在治疗6个月和12个月后接受细胞遗传学检查的患者比例分别为41.41%和27.35%。HSCT的平均费用为213 092 ± 125 890元人民币。
与西方国家相比，中国的CML患者发病年龄趋于年轻化。大多数患者在慢性期被诊断。由于经济支持的限制，只有三分之一的CML患者接受伊马替尼治疗，且大多数接受治疗的患者未得到及时监测。临床医生应关注加速期或急变期患者对伊马替尼治疗的耐药及不耐受情况。
