| Object:To survey the results on CML patients with the treatmet of IM therapy.Methods:Retrospective analysis method was performed to survey the clinic datas, including CCR rates,MMR rates,and drug resistant rates,in patients with CML in different clinic stages from Janarary,2001 to Janarary,2008.The chromosomes were analyzed by R- banding method.The expression level of bcr-abl fusion gene was assayed by Real-time PCR method.FISH study was used to detect the relapse in early stage and MDR.Results:(1) 117 patients,consisted of 77 males and 40 females,were grouped as different clinic stages,i.e,88 patients in CP including 59 in ECP with comparison to 29 in LCP,18 patients in AP as well as 11 patients in BC.(2) At 12 months after the initiation of imatinib,patients in ECP,LCP,AP achieved CCR rate of 69.5%(41/59),42.9%(12/28),22%(4/16),respectively.At 18 months,64 of 117 patients(57.6%) achieved CCR,the rates in patients in ECP,LCP,AP were 76%(45/59),46%(13/28),17%(3/18),respectively,only one patient got CCR at 12 and 18months in BC.(3) 46 of 117 patients achieved major molecular response(MMR) at 24 months,consisting of 27 of 59 in ECP(52.5%),13 of 28 in LCP(46.4%),and 27 of 59 in ECP(52.5%),but nobody got MMR in BC.There was no statistics significance found between these 3 groups.The expressive level of bcr-abl fusion gene in 5 patients increased from 13 to 24 months while the expression return to normal in all patients by add IM dose.(4) 33 of 117 patients(28%) were progressed to drug resistance including 10 of 60(16.7%)in ECP,7 of 28(25%)in LCP,8 of 18(44.4%) in AP,8 of 11(72.3%) in BC,respectively.The statistics significance was found between these 4 groups. Among the 33 patients,only one achieved CCR again by treatment with dastinib, another one got MMR,7 patients died in the study.The estimated OS rate at 5 year was 68.9%compared to 95.29%in non-drug resistance patients.(5) The estimated EFS rates were 95.6%,91.6%,84%and 51.8%at 1 year in ECP,LCP,AP and BC,83%,80.8%,42%and 0%at 3 years,respectively, whreas 80%in ECP and LCP at 5 years.The difference rank in different stages reached to 0.0012.(6) The estimated overall survival rate at 5 year was 89.65%,and that of patients in ECP and LCP were 95.75%,92.2%at 1,3,5 year,respectively. Meanwhile,the rates recched 87.4%and 53.87%in AP and BC at 1 year,79.45% and 35.91%at 3 year and 5 year,respectively.The statistics significance was found between these 4 groups.Additional,the estimated overall survival rate at 5 years was 94.1%and 89.6%in patients who got CCR and non-CCR(Log Rank=0.041), respectively.Meanwhile,it was 68.9%and 95.29%in patients with drug resistance and non-drug resistance,respectively. (7) FISH study were performed in 6 patients after IM treatment,negative results achieved in 5 patients in LCP and ECP while a 100%positive rates found in a patient in AP though treatment for 24 months.Conclusion:(1) Favorable outcomes of high rate of CCR and event-free survival and overall survival were achieved in CML patients treated with imatinib.But if IM was initiated in different clinic stages,i.e.ECP,LCP,AP and BC,the rate of CCR and event-free survival and overall survival decreased.(2) The different MMR rates after IM treatment at 24 months were achieved in patients in different clinic stages,such as ECP,LCP,AP,BC,But no statistics significance was found in these groups,the similar result was also found in overall survival rate between the patients who got MCR or not.(3) If IM was initiated in different clinic stages such as ECP,LCP,AP and BC, the earlier we used it,the less drug-resistant rate was achieved.Overall survival rate in the patients who developed IM resistance was lower than it in patients without IM resistance.Dasatinib may improve partly prognosis in our study.(4) We should initiate IM treatment as early as possible so as to get suboptimal response in patients.With dose increasement of IM,or other effective drugs,we can reduce the events of IM resistance and progression to BC in clinic practice.
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