Kloke O, Niederle N, Qiu J Y, Wandl U, Moritz T, Nagel-Hiemke M, Hawig I, Opalka B, Seeber S, Becher R
Department of Internal Medicine (Cancer Research), West German Cancer Centre Essen, University of Essen Medical School.
Br J Haematol. 1993 Mar;83(3):399-403. doi: 10.1111/j.1365-2141.1993.tb04663.x.
The objective of this study was to investigate the prognostic impact of the reduction of Philadelphia chromosome (Ph) positive metaphases by treatment of chronic myelogenous leukaemia (CML) with interferon (IFN) alpha. Therefore, we evaluated the outcome of patients with previously untreated chronic phase Ph-positive CML, enrolled from 1984 to 1990 into two consecutive IFN trials at our institution. Of a total of 71 patients, 62 (87%) were evaluable for cytogenetic response. No cytogenetic improvement was seen in 16 patients (23%), 28 patients (38%) had a decrease in Ph-positive bone marrow metaphases to levels ranging from 35% to 95%, and nine patients (13%) to levels between 5% and 34%. In nine patients (13%), Ph-positive metaphases were no longer detectable. After a median follow-up period of 33 months, the projected 5-year survival is 55% for the 62 patients evaluable for cytogenetic response. In this patient population there was no significant difference in the survival probability according to patients' risk status as defined by the Sokal score. Categorization according to the extent of Ph reduction, however, allowed three groups with significantly different prognoses to be identified. Patients achieving a Ph reduction to less than 35% were found to constitute a low risk group with a median survival not yet known and a projected 5-year survival of 90%. The 5-year survival rate was 55% for patients with a Ph reduction to levels between 35% and 95%, and less than 10% for those without any cytogenetic improvement. Thus, this study demonstrates that cytogenetic improvement on IFN treatment is an important prognostic factor for survival.
本研究的目的是探讨用α干扰素（IFN）治疗慢性粒细胞白血病（CML）时，费城染色体（Ph）阳性中期相减少对预后的影响。因此，我们评估了1984年至1990年期间在我们机构连续参加两项IFN试验的初治慢性期Ph阳性CML患者的结局。在总共71例患者中，62例（87%）可评估细胞遗传学反应。16例患者（23%）未见细胞遗传学改善，28例患者（38%）Ph阳性骨髓中期相减少至35%至95%，9例患者（13%）减少至5%至34%。9例患者（13%）不再能检测到Ph阳性中期相。在中位随访期33个月后，62例可评估细胞遗传学反应的患者预计5年生存率为55%。在该患者群体中，根据Sokal评分定义的患者风险状态，生存概率无显著差异。然而，根据Ph减少程度进行分类，可以确定三组预后显著不同的患者。Ph减少至低于35%的患者被发现构成低风险组，中位生存期未知，预计5年生存率为90%。Ph减少至35%至95%的患者5年生存率为55%，而无任何细胞遗传学改善的患者5年生存率低于10%。因此，本研究表明IFN治疗的细胞遗传学改善是生存的重要预后因素。
