Efficacy and safety evaluation of imatinib in the treatment of patients with chronic granulocytic leukemia in accelerated phase

目的评价伊马替尼治疗慢性粒细胞白血病(CGL)加速期的有效性与安全性.方法 30例成人CGL加速期患者口服伊马替尼 400 mg/d或600 mg/d,持续7～9个月.结果治疗7～9个月内,血液学完全缓解14例(46.7%),骨髓缓解10例(33.3%),回到慢性期4例(13.3%),总有效率为93.3%.白血病浸润症状或体征消失迅速.8例在获血液学效应后30～172 d复发,6例伊马替尼剂量增加为800 mg/d继续治疗后,4例无效,2例再次回到慢性期,另2例未予加量即退出方案.伊马替尼治疗前骨髓或外周血中原始细胞≥0.15、有髓外白细胞浸润并且Hb<100 g/L、伊马替尼治疗后未曾获得过血液学完全缓解者复发率显著增高.治疗3个月时,获得完全遗传学缓解4例(14.3%),大部分遗传学缓解2例(7.1%),遗传学有效应率为21.4%.轻度的非血液学不良反应发生普遍,多可耐受、可控制或可自行消退.严重的白细胞和(或)血小板减少占半数以上.结论伊马替尼治疗CGL加速期安全、有效,除血细胞减少外,不良反应多可耐受.To evaluate the efficacy and safety of imatinib in the treatment of adult patients with chronic granulocytic leukemia (CGL) in accelerated phase.Thirty patients with CGL in accelerated phase were orally administered with imatinib 400 or 600 mg daily for 7 approximately 9 months.Hematological responses occurred in 28 of 30 patients (93.3%) in the treatment: 14 (46.7%) had a complete hematological response, 10 (33.3%) had a marrow response, and 4 (13.3%) returned to chronic phase. Bone pain and splenomegaly disappeared soon after the administration of imatinib. Eight patients relapsed 30 approximately 172 days after hematological responses. Six of them received imatinib with daily dose increment to 800 mg. Four of these 6 patients had no response and 2 returned to chronic phase again. The risk factors for relapse were blasts > or = 15% in bone marrow or in peripheral blood, extramedullary leukemia involvement, hemoglobin < 100 g/L before the administration of imatinib, and lack of a complete hematological response after the treatment. Cytogenetic remission occurred in 6 of 27 patients (21.4%) after 3 months treatment: 4 (14.3%) were complete cytogenetic response and 2 (7.1%) major cytogenetic response. Mild non-hematologic adverse effects occurred in most of the patients, but were manageable and tolerable, or disappeared automatically. Severe neutropenia or thrombocytopenia appeared in more than half of the patients.Imatinib has substantial activity and is well-tolerated in the treatment of accelerated phase of CGL.PubMed中文核心期刊要目总览(PKU)中国科学引文数据库(CSCD)06333-3362