Yin H, Chen L F, Cui J K, Xiong Y Y, You Y, Zou P, Li W M
Department of Hematology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430022, China.
Zhonghua Nei Ke Za Zhi. 2017 Nov 1;56(11):810-815. doi: 10.3760/cma.j.issn.0578-1426.2017.11.007.
To compare the clinical efficacy and safety of nilotinib and imatinib as frontline therapy in newly diagnosed patients with chronic myeloid leukemia in chronic phase(CML-CP). Until December 31st 2016, 18 patients using nilotinib and 83 using imatinib were recruited in our study. The efficacy and safety of two groups were evaluated. A total of 101 patients with CML-CP included 18 receiving nilotinib and 83 imatinib. The optimal response rates at 3, 6, 12 and 18 months in nilotinib and imatinib group were 88.9% (16/18) vs 57.3% (47/82) (=0.012), 82.4% (14/17) vs 55.7% (44/79) (=0.041), 9/12 vs 63.9% (39/61) (=0.460), 6/9 vs 68.9% (31/45) (=0.896) respectively. The optimal response rates by 3 months in low sokal risk group on nilotinib and imatinib were 9/9 vs 76.5%(26/34) (=0.107), in intermediate and high sokal risk group were 7/8 vs 45.2%(14/31) (=0.032). At the end of follow-up, the rate of major molecular response (MMR) in nilotinib group was 72.2%, which was higher than 56.6% in imatinib group (=0.021). The rate of complete cytogenetic response (CCyR) in nilotinib group was 100%, which was higher than 71.1% in imatinib group ( = 0.002). Progression free survival (PFS) rates in nilotinib and imatinib groups were 94.4% and 98.8% (=0.019) respectively; whereas event free survival (EFS) rates were 88.9% and 48.2% (=0.045). The incidence of drug related adverse reactions in nilotinib and imatinib was similar with only minor proportion of grade 3/4 adverse reactions. Nilotinib achieves a deeper molecular response in a shorter time than imatinib in newly diagnosed patients with CML-CP, especially in patients with high risk outcome. Good safety is obtained in both groups so as to ensure a long-term administration and improving prognosis.
比较尼罗替尼和伊马替尼作为新诊断慢性期慢性髓性白血病(CML-CP)患者一线治疗的临床疗效和安全性。截至2016年12月31日,本研究招募了18例使用尼罗替尼的患者和83例使用伊马替尼的患者。评估了两组的疗效和安全性。共有101例CML-CP患者,其中18例接受尼罗替尼治疗,83例接受伊马替尼治疗。尼罗替尼组和伊马替尼组在3、6、12和18个月时的最佳缓解率分别为88.9%(16/18)对57.3%(47/82)(P=0.012)、82.4%(14/17)对55.7%(44/79)(P=0.041)、9/12对63.9%(39/61)(P=0.460)、6/9对68.9%(31/45)(P=0.896)。尼罗替尼和伊马替尼在低索卡尔风险组3个月时的最佳缓解率分别为9/9对76.5%(26/34)(P=0.107),在中高索卡尔风险组为7/8对45.2%(14/31)(P=0.032)。随访结束时,尼罗替尼组的主要分子反应(MMR)率为72.2%,高于伊马替尼组的56.6%(P=0.021)。尼罗替尼组的完全细胞遗传学缓解(CCyR)率为100%,高于伊马替尼组的71.1%(P=0.002)。尼罗替尼组和伊马替尼组的无进展生存期(PFS)率分别为94.4%和98.8%(P=0.019);而无事件生存期(EFS)率分别为88.9%和48.2%(P=0.045)。尼罗替尼和伊马替尼的药物相关不良反应发生率相似,只有一小部分3/4级不良反应。在新诊断的CML-CP患者中,尼罗替尼比伊马替尼能在更短时间内获得更深的分子反应,尤其是在高风险患者中。两组均具有良好的安全性,以确保长期给药并改善预后。