Wan Y L, Wang Y, Liu B C, Liu X, Gong X Y, Zhao X L, Wang T Y, Jiang E L, Feng S Z, Han M Z, Qiu L G, Mi Y C, Wang J X
Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China.
Zhonghua Xue Ye Xue Za Zhi. 2016 Oct 14;37(10):886-891. doi: 10.3760/cma.j.issn.0253-2727.2016.10.014.
To explore the efficacy and prognostic factors of imatinib(IM)combined with chemotherapy for BCR-ABL gene positive acute lymphoblastic leukemia(ALL). A total of 209 BCR-ABLALL patients treated with imatinib plus chemotherapy from April 2003 to August 2015 were enrolled in the study, and 106 patients underwent hematopoietic stem cell transplantation(HSCT). The complete remission(CR)rate was 97.9% in newly diagnosed patients. WBC≥100×10/L at diagnosis was a poor factor for overall survival(OS)(=0.043). Without HSCT, not achieved CR within 4 weeks in the first cycle induction chemotherapy and complete molecular remission(CMR)not achieved during the treatment were adverse factors for OS(<0.001, =0.009, <0.001, respectively), as well as for relapse free survival(RFS)(<0.001, <0.001 and <0.001, respectively). Of the 106 patients who underwent allo-HSCT or auto-HSCT, there was no statistically significant difference on the OS and RFS. There was no significant difference on OS in patients treated with imatinib or not in the induction chemotherapy, but the former showed higher 5-year RFS rate(37.0% 24.0%, =0.005). The survival of the patients who took tyrosine kinase inhibitors(TKIs)regularly and continuously was the best(40 patients changed to other TKI due to relapse/unsatisfactory decrease in transcription level/occurrence of mutation), followed by those who interrupted TKIs during the bone marrow suppression, those who took TKIs irregularly the worst. The 5- year OS rates among three groups were 46.0%, 28.0% and 17.0%, respectively(=0.004). The 5- year EFS rates among three groups were 38.0%, 28.0% and 17.0%, respectively(<0.001). TKIs plus chemotherapy followed by HSCT improved the prognosis of the patients with BCR-ABLALL patients. It is important to administer TKIs regularly and continuously to improve the outcome of BCR-ABLALL patients.
探讨伊马替尼（IM）联合化疗治疗BCR-ABL基因阳性急性淋巴细胞白血病（ALL）的疗效及预后因素。本研究纳入了2003年4月至2015年8月期间接受伊马替尼联合化疗的209例BCR-ABL ALL患者，其中106例患者接受了造血干细胞移植（HSCT）。新诊断患者的完全缓解（CR）率为97.9%。诊断时白细胞≥100×10⁹/L是总生存（OS）的不良因素（P = 0.043）。未进行HSCT时，第1周期诱导化疗4周内未达到CR以及治疗期间未达到完全分子缓解（CMR）是OS的不良因素（分别为P<0.001、P = 0.009、P<0.001），也是无复发生存（RFS）的不良因素（分别为P<0.001、P<0.001和P<0.001）。在106例接受异基因HSCT或自体HSCT的患者中，OS和RFS无统计学显著差异。诱导化疗时使用伊马替尼与否的患者OS无显著差异，但前者5年RFS率更高（37.0%对24.0%，P = 0.005）。定期持续服用酪氨酸激酶抑制剂（TKIs）的患者生存情况最佳（40例因复发/转录水平下降不满意/发生突变而更换为其他TKI），其次是骨髓抑制期间中断TKIs的患者，不定期服用TKIs的患者最差。三组患者的5年OS率分别为46.0%、28.0%和17.0%（P = 0.004）。三组患者的5年无事件生存（EFS）率分别为38.0%、28.0%和17.0%（P<0.001）。TKIs联合化疗后行HSCT改善了BCR-ABL ALL患者的预后。定期持续给予TKIs对改善BCR-ABL ALL患者的结局很重要。
