| Object:Analysis of newly diagnosed or imatinib resistance/intolerance CML patients who treated with dasatinib treatment,patients with large granular lymphocytecounts increased compared withthose who did not in the peripheral blood,whether there are differences in the degree and time.of obtaining the depth molecular response(DMR).Method:The case-control study design method was adopted.To collect the 25 cases of CML patients whowere adimitted to the Qingdao Municipal Hospital Department of Hematology outpatient and hospitalized,from January 2014 to January 2017.There were 7 female patients and 18 male patients.5 cases of 25 patients with newly diagnosed patients,including 1 cases of accelerated phase,4 cases of chronic phase.Imatinib resistance/intolerance in 20 patients,including imatinib resistant patients in 3 cases,imatinib intolerance in 17 patients,incluing 16 cases of chronic phase,4 cases of acute period.25 cases on the application of dasatinib before therapy and 1,2,3,6,9,12,15,18 months after treatment,lymphocyte subsets in peripheral blood were measured by flow cytometry,and the number of NK cells and the count of killer T lymphocyte were recorded.At the same time in the application of dasatinib before therapy and 1,3,6,9,12 months after treatment,the gene expression level of BCR-ABLwas detected by using reverse transcription polymerase chain reaction,and the number of BCR-ABL copies,the number of ABL copies,and BCR-ABLIS were recorded.According to the records of the results of applying dasatinib after treatment of large granular lymphocytecounts increasedin the peripheral blood in CML patients as case group(LGL+ group),did not increase CML patients as control group(LGL-group).And during dasatinib treatment periodic review of blood routine,blood biochemistry,bone marrow cell morphology,chromosome karyotype analysis and BCR-ABL fusion gene mutation detection index,in order to provide clinical reference for the therapeutic effect.Result:The date for the applicationof dasatinib therapy began until 18 months after the treatment.25 CML patients were treated with dasatinib after treatment with 15 CML patients(60%)of large particles in the peripheral blood lymphocyte count(LGL),10 cases of CML were not increased.The number of large particles in the peripheral blood of 5 patients with newly diagnosed CML increased.Of 20 imatinib resistant / imatinib resistant CML patients,10 patients had increased peripheral blood large granular lymphocyte count,including 9 cases of chronic phase and 1 cases of accelerated phase.10 cases were not increased for imatinib resistant / imatinib intolerant CML patients,including 7 cases of chronic phase,3 cases of acute period.15 cases group(LGL+ group)in 5 cases of CML patients received deep molecular reaction of DMR(33.3%)(including 2 cases of newly diagnosed chronic phase and 1 cases of newly diagnosed accelerated phase patients,with imatinib resistant / imatinib intolerance in 2 cases of chronic phase)was significantly higher than the control group(33.3%vs10%),10 cases in the control group(LGL-group)in 1 CML patient received deep molecular reaction of DMR(10%)(imatinib resistant / imatinib 1 cases of tolerance in chronic phase)(P < 0.05),said the difference was statistically significant.The case group(LGL+ group)with CML depth DMR molecular response for a median of 12 months,significantly lower than the control group(LGL-group),patients in the control group received deep molecular reaction DMR the median time was 15 months(P < 0.05)said the difference was statistically significant.Conclusion:Newly diagnosed and imatinib resistance/ ntolerance CML patients using the second generation TKI drug dasatinib after treatment,the number of large granular lymphocyte counts was increased in the peripheral blood in some patients.Large granular lymphocyte counts increased can improve the efficacy of dasatinib treatment of CML patients,and can make the CML patients get deeper molecular responses,so as to prolong the survival of patients. |
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