尼洛替尼或达沙替尼治疗慢性髓性白血病患者衍生染色体 9 缺失的预后影响。
Prognostic impact of deletions of derivative chromosome 9 in patients with chronic myelogenous leukemia treated with nilotinib or dasatinib.
机构信息
Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
出版信息
Cancer. 2011 Nov 15;117(22):5085-93. doi: 10.1002/cncr.26147. Epub 2011 Apr 26.
BACKGROUND
Deletions of derivative chromosome 9 are a poor prognostic factor in patients with chronic myeloid leukemia (CML) treated with hydroxyurea, interferon, or stem cell transplantation. Imatinib may overcome the adverse prognostic impact of deletions of derivative chromosome 9.
METHODS
A study was undertaken to investigate the prognostic impact of deletions of derivative chromosome 9 in 353 patients with CML receiving the second generation tyrosine kinase inhibitors (TKIs) nilotinib (n = 161) or dasatinib (n = 192).
RESULTS
Deletion of derivative chromosome 9 status was determined in 245 (69%). Twenty-eight (11%) patients, 22 in chronic phase, 4 in accelerated phase, and 2 in blast phase, carried deletions of derivative chromosome 9, including 17 receiving nilotinib and 11 receiving dasatinib (P = .47). Overall survival (OS) at 24 months was similar between patients with or without deletions of derivative chromosome 9 (70% vs 71%, P = .76). For patients in chronic phase, no significant differences in overall major cytogenetic response (77% vs 82%, P = .57) or complete cytogenetic response (77% vs 81%, P = .71) rates were observed between patients with or without deletions of derivative chromosome 9. At 24 months, patients with CML in chronic phase without deletions of derivative chromosome 9 had improved event-free survival (EFS) (88% vs 66%, P = .07) and OS (96% vs 82%; P = .08) compared with those carrying deletions of derivative chromosome 9. However, multivariate analysis established second-line versus frontline second generation TKI therapy as the only adverse prognostic factor for EFS and increased bone marrow blast burden and older age as independent adverse prognostic factors for OS.
CONCLUSIONS
Deletions of derivative chromosome 9 do not appear to be an independent risk factor for survival among patients with CML in chronic phase receiving second generation TKIs.
背景
在接受羟基脲、干扰素或干细胞移植治疗的慢性髓性白血病（CML）患者中，衍生 9 号染色体缺失是预后不良的因素。伊马替尼可能克服衍生 9 号染色体缺失对预后的不利影响。
方法
本研究旨在探讨 353 例接受第二代酪氨酸激酶抑制剂（TKI）尼洛替尼（n = 161）或达沙替尼（n = 192）治疗的 CML 患者中衍生 9 号染色体缺失的预后影响。
结果
在 245 例（69%）患者中确定了衍生 9 号染色体缺失的状态。28 例（11%）患者发生衍生 9 号染色体缺失，其中 22 例处于慢性期，4 例处于加速期，2 例处于急变期，其中 17 例接受尼洛替尼治疗，11 例接受达沙替尼治疗（P =.47）。24 个月时，有无衍生 9 号染色体缺失的患者的总生存（OS）相似（70%比 71%，P =.76）。对于慢性期患者，有无衍生 9 号染色体缺失的患者的总体主要细胞遗传学反应（77%比 82%，P =.57）或完全细胞遗传学反应（77%比 81%，P =.71）率无显著差异。24 个月时，无衍生 9 号染色体缺失的慢性期 CML 患者的无事件生存（EFS）（88%比 66%，P =.07）和 OS（96%比 82%；P =.08）均优于携带衍生 9 号染色体缺失的患者。然而，多变量分析确定二线与一线第二代 TKI 治疗是 EFS 的唯一不良预后因素，骨髓原始细胞负荷增加和年龄较大是 OS 的独立不良预后因素。
结论
在接受第二代 TKI 治疗的慢性期 CML 患者中，衍生 9 号染色体缺失似乎不是生存的独立危险因素。
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