慢性粒细胞白血病患者减量至停用酪氨酸激酶抑制剂的临床分析

Abstract
Figure/Table
References (20)
Related Citation (15)

Download: PDF (503 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS)

Abstract

Objective To observe and analyze the clinical manifestations and outcomes of chronic myelogenous leukemia(CML)patients treated with tyrosine kinase inhibitor (TKI)after drug discontinuation criteria.Methods The clinical data of 44 eligible CML patients who discontinued TKI from January 1,2015 to December 31,2017 in the Department of Hematology of Guangdong Huazhong University of Science and Technology Union Shenzhen Hospital and were followed up for a long time were retrospectively analyzed,and the situation of treaty-free remission after discontinuation of TKI and its influencing factors were observed.Results The median time of 44 patients receiving TKI was 59.5 (37,102) months.Among them,40 patients had a history of reduction.All patients obtained the efficacy of major molecular remission(MMR)or above before discontinuation.At a median follow-up of 15(5,30)months,34 patients(77.27%)achieved long-term treatment free remission (TFR).Ten patients (22.73%) lost MMR.In 10 patients who lost MMR,drug therapy was restarted,and 8 of them achieved efficacy above MMR after restart.Kaplan-Meier method was used to analyze the clinical characteristics of 44 patients before drug discontinuation,34 patients finally obtained TFR,and 10 patients relapsed after drug discontinuation,with a recurrence rate of 29.41%.Univariate analysis showed that there were no significant differences in gender,age,MMR acquisition time and Sokal score between the two groups (P＞0.05).The difference was statistically significant in the recurrence rate between patients with MMR maintenance time＜24 months before drug discontinuation and patients with MMR maintenance time≥24 months before drug discontinuation (P＜0.05).Multivariate analysis by logistic regression model showed that MMR maintenance time＜24 months (β=0.519,OR=2.951,95%CI=1.187-7.526) was an independent risk factor for molecular relapse in CML patients (P＜0.05).Conclusion TKI can be stopped only after CML patients meet the criteria for drug discontinuation,and the longer MMR maintenance time before drug discontinuation,the lower the recurrence rate of patients after drug discontinuation.

Key words： Chronic myelogenous leukemia Relapse Tyrosine kinase inhibitor Drug discontinuation

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors

Cite this article:

URL:

https://www.dangdaiyiyao.com/EN/ OR https://www.dangdaiyiyao.com/EN/Y2024/V31/I12/23

[1]	杨岚，任慧娟，韩艳秋.酪氨酸激酶抑制剂治疗老年Ph 阳性慢性粒细胞白血病的临床观察[J].老年医学与保健，2020，26（1）：95-100.
[2]	杨菲菲，张丽勤，沈颖，等.Bcr-Abl 酪氨酸激酶抑制剂联合用药治疗慢性粒细胞白血病研究进展[J].中国新药与临床杂志，2020，39（2）：71-75.
[3]	王小兵.酪氨酸激酶抑制剂治疗慢性粒细胞白血病的疗效分析[J].基层医学论坛，2019，33（32）：4732-4733.
[4]	Sasaki K，Strom SS，O'Brien S，et al.Relative survival in patients with chronic-phase chronic myeloid leukaemia in the tyrosine-kinase inhibitor era：analysis of patient data from six prospective clinical trials[J].Lancet Haematol，2015，2（3）：e186-e193.
[5]	Ross DM，Branford S，Seymour F，et al.Safety and efficacy of imatinib cessation for CML patients with stable undetectable minimal residual disease：Resultsfrom the TWISTER study[J].Blood，2013，122（4）：515-522.
[6]	朱晓健，游泳，段明辉，等.慢性髓性白血病患者酪氨酸激酶抑制剂自动停药的多中心回顾性研究[J].中华血液学杂志，2018，39（12）：994-997.
[7]	邹银珍，孔银燕.二代酪氨酸激酶抑制剂治疗慢性粒细胞白血病的安全性[J].中国药物经济学，2019，14（7）：62-65.
[8]	胡成俊，沈云峰，周新，等.不同酪氨酸激酶抑制剂对慢性粒细胞白血病患者不良反应分析及生活质量影响[J].临床血液学杂志，2019，32（7）：532-534.
[9]	刘晓蕾.酪氨酸激酶抑制剂治疗慢性粒细胞白血病的临床疗效分析[J].世界复合医学，2019，5（3）：80-82.
[10]	Bower HM，Dickman W，et al.Life expectancy of patients with chronic myeloid leukemia approaches the life expectancy of the general population[J].J Clin Oncol，2016，34（24）：2851-2857.
[11]	Etienne G，Guilhot J，Rea D，et al.Long-term follow-up of the French Stop Imatinib（STIM1）study in patients with chronic myeloid leukemia[J].J Clin Oncol，2017，35（3）：298-305.
[12]	Kimura S，Imagawa J，Murai K，et al.Treatment-free remission after first-line dasatinib discontinuation in patients with chronic myeloid leukaemia（first-line DADI trial）：a single-arm，multicentre，phase 2 trial[J].Lancet Haematol，2020，7（3）：e218-e225.
[13]	Saussele S，Richter J，Guilhot J，et al.Discontinuation of tyrosine kinase inhibitor therapy in chronic myeloid leukaemia（EURO-SKI）：a prespecified interim analysis of a prospective，multicentre，non-randomised，trial[J].LancetOncol，2018，19（6）：747-757.
[14]	Aleem A，Alotaibi G，Iqbal Z，et al.Eltrombopag for tyrosine kinase inhibitors-associated thrombocytopenia in chronic myeloid leukemia[J].Int J Hematol，2023，118（2）：288-291.
[15]	Kaehler M，Cascorbi I.Molecular Mechanisms of Tyrosine Kinase Inhibitor Resistance in Chronic Myeloid Leukemia[J].Handb Exp Pharmacol，2023，280（21）：65-83.
[16]	Chen B，Dai H，Yang J，et al.Transarterial Chemoembolization Followed by Hepatic Arterial Infusion Chemotherapy Combined a Tyrosine Kinase Inhibitor for Treatment of Large Hepatocellular Carcinoma[J].Curr Cancer Drug Targets，2023，23（7）：564-571.
[17]	刘炎炎.酪氨酸激酶抑制剂治疗慢性粒细胞白血病的疗效分析[J].山东医学高等专科学校学报，2023，45（1）：3-5.
[18]	Iinuma K，Yamada T，Kameyama K，et al.The Efficacy and Safety of Immune Checkpoint Inhibitor and Tyrosine Kinase Inhibitor Combination Therapy for Advanced or Metastatic Renal Cell Carcinoma：A Multicenter Retrospective Real-World Cohort Study[J].Cancers（Basel），2023，15（3）：947.
[19]	高娜.酪氨酸激酶抑制剂治疗老年Ph 阳性慢性粒细胞白血病的临床有效性研究[J].名医，2020（12）：303-304.
[20]	何思润，秦群，徐文泉.酪氨酸激酶抑制剂治疗慢性粒细胞白血病的不良反应及临床对策[J].中国现代应用药学，2020，33（7）：963-966.