Clinical Efficacy Of Imatinib And Dasatinib In Children ALL With BCR/ABL(+)

Objective:BCR/ABL(+)suggests a poor prognosis in children ALL.The molecular targeted drug tyrosine kinase inhibitor(TKI)improves the survival rate of this disease.Generation I and II TKI have advantages and disadvantages as well as corresponding toxicity in children ALL.The purpose of this study is to compare and analyze the clinical characteristics,efficacy,adverse reactions,EFS,OS,etc.of the I and II generation TKI in the treatment process,so as to provide reference for clinical treatment.Methods:All children with BCR/ABL(+)admitted to Kunming Children’s Hospital from January 1,2015 to January 31,2015 were collected,and their age of onset,gender,initial hemogram,clinical characteristics,and genotyping were statistically analyzed.They were grouped according to the type of medication,and the adverse reactions and efficacy during medication were compared,and the survival prognosis was analyzed.Results:1.Among the 47 samples,there were 26 males and 21 females,with a male-to-female ratio of 26:21.The median age of onset was 8 years old and 10 months(August 1 year old to April 14 year old),of which the most patients were from 1 to 10 years old,accounting for 63.83%(30/47).2.Among the 47 samples,the median WBC at onset was 64.26x109/L(0.53-547.2×109/L),and there were 19(40.43%)WBC counts≥100×109/L.There were 32 cases(68.08%,32/47)of BCR/ABL(+)protein qualitative P190,14 cases(29.79%,14/47)of P210,and 1 case(2.13%,1/47)of both P190 and P210.Bone marrow immunization was B-ALL.3.In the imatinib group,there were 11 cases(45.8%)with gene turning negative for less than 3 months,and 15 cases(65.2%)with gene turning negative for less than 3 months in the dasatinib group.Through statistical comparison,P=0.181(P value>0.05,no statistical significance),there was no significant difference in gene turning negative rate between dasatinib and imatinib in the early stage.4.There were 6 cases(25%)of drug resistance in the imatinib group,but no drug resistance in the dasatinib group.Through statistical comparison,P=0.022(P<0.05,statistically significant),indicating that dasatinib was less likely to develop drug resistance.5.The bone marrow remission status was compared.In the 19th day MRD,13 cases(54.2%)in the imatinib group and 12 cases(52.2%)in the dasatinib group were found to be in remission.In the 46th day MRD,19 cases(79.2%)in the imatinib group and 20 cases(87.0%)in the dasatinib group were found to have remission.Through comparative analysis,P=0.52(P>0.05,no statistical difference),there was no significant difference in the degree of bone marrow remission between the two drugs on the 46th day.6.Adverse reactions occurred in 12 children(52.2%)in the dasatinib group and 11 children(45.8%)in the imatinib group.By comparison,P=0.773(P>0.05,no statistical difference),indicating no significant difference in ADR between the two drugs.According to the classification of CTCAEV4.0,the ADR level of the two drugs was mostly 1-2.7.Log-rank survival analysis was used to compare the 3-year OS rate and EFS rate of the dasatinib group and the imatinib group,and the P values were 0.044 and 0.005 respectively(P<0.05,which was statistically significant),indicating that dasatinib was superior to imatinib in terms of survival.Conclusions:1.Children ALL with BCR/ABL(+)are more prone to ALL in children aged 1-10 years,males are more prone than females,white blood cells are higher at onset,B-ALL is more common in immunotyping and BCR/ABL(P190)is more common in protein characterization.2.Dasatinib was superior to imatinib in overall survival and event-free survival.3.There was no significant difference between dasatinib and imatinib in adverse drug reactions,and both of them had good safety.