Department of Medical Oncology and Hematology, Princess Margaret Hospital, University Health Network, University of Toronto, Ontario, Canada.
Am J Hematol. 2014 Jun;89(6):626-32. doi: 10.1002/ajh.23707. Epub 2014 Apr 10.
It is unclear if patients with CML treated with imatinib who fail to achieve BCR/ABL transcript levels <10%(IS) at 3 months i.e. an early molecular response (EMR) have a better prognosis if they achieve a response by 6 months. We reviewed 320 patients with chronic myeloid leukemia (CML) in chronic phase receiving Imatinib therapy with 3 and 6 month BCR/ABL transcript levels available, and divided them into four groups. Group I (achieved an EMR at 3 months), Group II (did not achieve an EMR at 3 months, but achieved a transcript level of <1% at 6 months), Group III (did not achieve an EMR at 3 months, then at 6 months achieved a level between 1% and 10%) and Group IV (failed to achieve a response at 3 and 6 months). Compared to Group I, Group IV showed significantly worse freedom from treatment failure (FTF; 93.1% vs 69.0%, P < 0.001), progression free survival (97.7% vs 77.3%, P < 0.001) and overall survival (98.3% vs 78.9%, P < 0.001). While, group III showed inferior PFS (98.3% vs 90.4%, P = 0.013) and OS (97.7% vs 90.4%, P = 0.037), but no difference in FTF (93.1% vs 92.0%, P = 0.520). There were no significant differences between Groups I and II. A BCR/ABL transcript level at 6 months can identify a "good-risk" subgroup among patients who fail to achieve an EMR on Imatinib therapy for CML.
对于在 3 个月时未能达到 BCR/ABL 转录水平<10%（IS）即早期分子反应（EMR）的接受伊马替尼治疗的 CML 患者，如果在 6 个月时达到缓解，他们的预后是否更好尚不清楚。我们回顾了 320 例接受伊马替尼治疗的慢性期慢性髓性白血病（CML）患者的资料，这些患者在 3 个月和 6 个月时有 BCR/ABL 转录水平的记录，并将他们分为四组。第 I 组（在 3 个月时达到 EMR），第 II 组（在 3 个月时未达到 EMR，但在 6 个月时达到转录水平<1%），第 III 组（在 3 个月时未达到 EMR，然后在 6 个月时达到 1%至 10%之间的水平），第 IV 组（在 3 个月和 6 个月时未达到反应）。与第 I 组相比，第 IV 组的无治疗失败率（FTF；93.1%比 69.0%，P<0.001）、无进展生存率（97.7%比 77.3%，P<0.001）和总生存率（98.3%比 78.9%，P<0.001）显著更差。而第 III 组的 PFS（98.3%比 90.4%，P=0.013）和 OS（97.7%比 90.4%，P=0.037）较差，但 FTF 无差异（93.1%比 92.0%，P=0.520）。第 I 组和第 II 组之间没有显著差异。在伊马替尼治疗 CML 未能达到 EMR 的患者中，6 个月时的 BCR/ABL 转录水平可识别出“低危”亚组。
