Cortes J, Talpaz M, O'Brien S, Rios M B, Majlis A, Keating M, Freireich E J, Kantarjian H
Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
J Clin Oncol. 1998 Oct;16(10):3279-85. doi: 10.1200/JCO.1998.16.10.3279.
To investigate whether cytogenetic clonal evolution can be suppressed with interferon alfa (IFN-alpha) therapy in patients with chronic myelogenous leukemia (CML).
Ninety patients with CML and cytogenetic clonal evolution who received IFN-alpha-based regimens were analyzed. Clonal evolution was defined as the presence of karyotypic abnormalities in addition to the Philadelphia (Ph) chromosome. Patients were evaluated for the suppression of cytogenetic clonal evolution after therapy, the cytogenetic response, and survival.
The median age of the population was 39 years (range, 15 to 70 years), median time from diagnosis to clonal evolution 14 months (range, 0 to 145 months), and median percentage of abnormal metaphases 18% (range, 4% to 100%). Fifty six patients (62%) achieved some suppression of cytogenetic clonal evolution; in 41 patients (46%), the suppression was complete. The overall median survival was 51 months, with 43% alive at 5 years. Patients who achieved a complete suppression of cytogenetic clonal evolution had a median survival of 66 months, with 51% alive at 5 years. Characteristics associated with a better response include a lower percentage of abnormal metaphases, time to cytogenetic clonal evolution of 24 months or less, and absence of other features of accelerated disease. A prognostic classification for cytogenetic clonal evolution defined three groups with complete response (CR) rates of 85%, 34%, and 0% (P < .0001) and median survival times of 58, 31, and 30 months, respectively (P=.02).
Patients with cytogenetic clonal evolution can respond to IFN-alpha therapy, and this response is associated with longer survival. A previously described prognostic model separates patients into subsets with different probabilities of response to IFN-alpha and survival.
研究干扰素α（IFN-α）治疗能否抑制慢性粒细胞白血病（CML）患者的细胞遗传学克隆演变。
分析90例接受基于IFN-α方案治疗的CML及细胞遗传学克隆演变患者。克隆演变定义为除费城（Ph）染色体外还存在核型异常。评估患者治疗后细胞遗传学克隆演变的抑制情况、细胞遗传学反应及生存情况。
患者中位年龄39岁（范围15至70岁），从诊断到克隆演变的中位时间为14个月（范围0至145个月），异常中期细胞的中位百分比为18%（范围4%至100%）。56例患者（62%）实现了细胞遗传学克隆演变的部分抑制；41例患者（46%）实现了完全抑制。总体中位生存期为51个月，5年生存率为43%。实现细胞遗传学克隆演变完全抑制的患者中位生存期为66个月，5年生存率为51%。反应较好的相关特征包括异常中期细胞百分比更低、细胞遗传学克隆演变时间为24个月或更短以及无加速期疾病的其他特征。细胞遗传学克隆演变的预后分类定义了三组，完全缓解（CR）率分别为85%、34%和0%（P <.0001），中位生存时间分别为58、31和30个月（P =.02）。
细胞遗传学克隆演变患者对IFN-α治疗有反应，且这种反应与更长生存期相关。先前描述的预后模型将患者分为对IFN-α反应和生存概率不同的亚组。
