Haematology Department, Royal Liverpool University Hospital, Liverpool, UK.
Leuk Res. 2013 Jul;37(7):752-8. doi: 10.1016/j.leukres.2013.04.003. Epub 2013 Apr 22.
Population based data suggest the proportion of patients failing imatinib in chronic myeloid leukaemia (CML) is higher than the reported one-third of patients in clinical trials. Clinical trials have demonstrated second generation tyrosine kinase inhibitors (TKI) dasatinib and nilotinib can restore complete cytogenetic remission (CCR) and major molecular response (MMR) to many patients failing imatinib, but their impact in the general population is not clear.
We report CML outcome in a population of 2.3 million people in a geographically contiguous area of North West England and North Wales.
Between 2003 and 2009, 192 new CML cases were diagnosed, of whom 184 were in chronic phase and 160 started on imatinib. The maximal CCR rate was 65% at 24 months and the maximal MMR rate was 50% at 36 months. Patients diagnosed since second generation TKI became available for imatinib failure had a more rapid cumulative CCR and MMR rate and a significantly improved progression free survival (p=0.022) than those diagnosed before this time.
The study indicates that second generation TKI have improved CML outcome in the general population.
基于人群的数据表明，慢性髓性白血病（CML）患者对伊马替尼耐药的比例高于临床试验报告的三分之一。临床试验已经证明，第二代酪氨酸激酶抑制剂（TKI）达沙替尼和尼洛替尼可以使许多伊马替尼耐药的患者恢复完全细胞遗传学缓解（CCR）和主要分子缓解（MMR），但其在普通人群中的影响尚不清楚。
我们报告了英格兰西北部和威尔士北部一个地理上连续的 230 万人的 CML 结局。
2003 年至 2009 年间，诊断出 192 例新的 CML 病例，其中 184 例处于慢性期，160 例开始接受伊马替尼治疗。24 个月时最大 CCR 率为 65%，36 个月时最大 MMR 率为 50%。自第二代 TKI 可用于伊马替尼耐药以来诊断出的患者，其累积 CCR 和 MMR 率更快，无进展生存时间显著改善（p=0.022）。
本研究表明，第二代 TKI 改善了普通人群中 CML 的预后。
