Department of Leukemia, M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA.
Blood. 2012 Mar 1;119(9):1981-7. doi: 10.1182/blood-2011-08-358135. Epub 2012 Jan 6.
A total of 1569 patients with chronic myeloid leukemia (CML) referred to our institution within 1 month of diagnosis since 1965 were reviewed: 1148 chronic phase (CP), 175 accelerated phase (AP), and 246 blastic phase (BP). The median survival was 8.9 years in CP, 4.8 years in AP, and 6 months in BP. In CP, the 8-year survival was ≤ 15% before 1983, 42%-65% from 1983-2000, and 87% since 2001. Survival was worse in older patients (P = .004), but this was less significant since 2001 (P = .07). Survival by Sokal risk was significantly different before 2001 (P < .001), but not since 2001 (P = .4). In AP, survival improved over time (P < .001); the 8-year survival in patients treated since 2001 was 75%. Survival by age was not different in years < 2001 (P = .09), but was better since 2001 in patients ≤ 70 years of age (P = .004). In BP, the median survival improved over time (P < .001), although it has been only 7 months since 2001. In summary, survival in CML has significantly improved since 2001, particularly so in CP-AML and AP-CML. Imatinib therapy minimized the impact of known prognostic factors and Sokal risk in CP-CML and accentuated the impact of age in AP- and BP-CML.
共有 1569 例慢性髓性白血病（CML）患者于 1965 年以来确诊后 1 个月内被转诊至我院：1148 例处于慢性期（CP），175 例处于加速期（AP），246 例处于急变期（BP）。CP 期的中位生存期为 8.9 年，AP 期为 4.8 年，BP 期为 6 个月。CP 期患者中，1983 年之前的 8 年生存率≤15%，1983-2000 年为 42%-65%，2001 年以来为 87%。年龄较大的患者（P =.004）生存率较差，但 2001 年以来这一差异不显著（P =.07）。2001 年之前 Sokal 风险分组的生存率存在显著差异（P <.001），但之后无差异（P =.4）。AP 期患者的生存率随时间推移而改善（P <.001）；2001 年以来接受治疗的患者的 8 年生存率为 75%。2001 年之前，年龄对生存率的影响无差异（P =.09），但 2001 年之后，≤70 岁患者的生存率较好（P =.004）。BP 期患者的中位生存期随时间推移而改善（P <.001），尽管 2001 年以来仅 7 个月。总之，2001 年以来 CML 的生存率显著提高，尤其是 CP-AML 和 AP-CML。伊马替尼治疗最小化了已知预后因素和 CP-CML 中 Sokal 风险的影响，并突出了 AP-和 BP-CML 中年龄的影响。
