Study Of Clinical Treatment Of Chronic Myeloid Leukemia

Part one To evaluate the effect of Imatinib on treatment of214patientswith chronic myeloid leukemia and Multivariate Analysis ImatinibResistance factors For CML patientsObjectiveTo discuss curative effect of imatinib and imatinib resistance-related factors forchronic myeloid leukemia patients.Methods214patients of chronic myeloid leukemia received imatinib treatment in our hospitalfrom April2005to December2010. The therapy history and curative effect were regularfollowed up at outpatient ward in our hospital and influencing factors of drug resistancewere analyzed. Cox regression analysis was used to perform the single factor andmulti-factors analysis.ResultsTo the deadline, thirty-one patients(14.49%) appeared drug resistance.One of themwas in accelerate phase, and two of them were in blastic phase.69.2%patients achievedcomplete cytogenetic response(CCyR).31.3%patients achieved major molecularresponse(MMR). We performed cox analysis with the207patients who were in chronicphase.Single factor cox regression analysis showed:the course before treatment、thehemoglobin count、the white blood cell count、whether achieved complete cytogeneticresponse or not and whether achieved major molecular response or not are the influencingfactors for imatinib resistance. The result of multi-factors cox regression analysis: whether achieved complete cytogenetic response or not is the independent factor which influencesdrug resistance.ConclusionsWe summarized from214chronic myeloid leukemia patients receiving imatinib andthirty-one patients(14.5%) appeared drug resistance.One hundread and forty-eightpatients achieved complete cytogenetic response(CCyR) with a proportion of69.2%.Sixty-seven patients achieved major molecular response(MMR) with a proportionof31.3%.（2）Whether achieved complete cytogenetic response or not is the independentfactor which influences imatinib resistance for chronic myeloid leukemia patients, and it’sa protective factor. Part two To discuss the treatment for the thirteen BCR-ABL positiveleukemia patients with the T315I mutationObjectiveTo discuss the curative effect for the leukemia patients with the T315I mutation,and todiscuss on how to choose the treatment preliminarily.MethodsWe assessed thirteen leukemia patients with the T315I mutation from January2010toJanuary2013through retrospective analysis(four CML cases in blastic phase, nine ALLcases with Ph chromosome positive); The therapy history,curative effect and prognosiswere followed up.Results6cases of the first11leukemia patients with T315I mutation underwent allogeneichematopoietic stem cell transplantation, and4cases were alive to the time offollow-up(including1case of recurrence after transplantation but was still alive),the left2cases who recurred after transplantation were dead; The other5cases who don’t underwenttransplant died.(2)The cases of12and13both underwent allogeneic hematopoietic stem cell transplantation and the T315I mutation was detected after the recurrence ofdisease,and1case was alive to the time of follow-up.ConclusionsTo the leukemia patients with T315I mutation,allogeneic hematopoietic stem celltransplantation is the only way to cure; Homoharringtonine may be a new treatment;It canprovides an opportunity for allogeneic hematopoietic stem cell transplantation,and then geta better curative effect. Part three To contrast the effect of Imatinib and Allogeneichematopoietic stem cell transplantation in the treatment of chronicmyeloid leukemiaObjectiveTo compare the curative effect of imatinib and allogeneic hematopoietic stem celltransplantation in the treatment of chronic myeloid leukemia.Methods433patients of chronic myeloid leukemia received imatinib or allogeneichematopoietic stem cell transplantation from March2001to October2012.Compared theevent free survival (EFS) and overall survival (OS) between the two groups.Results(1)The EFS of the group of imatinib(CML in the chronic phase) was88.5%, and theOS was93.2%,while the expected5-year EFS was84%and the expected5-year OS was92%. The EFS of the group of allogeneic hematopoietic stem cell transplantation (CML inthe chronic phase) was70%, and the OS was80%,while the expected5-year EFS was75%and the expected5-year OS was79%.To compare between the two groups,the EFS and OSof the group of imatinib were significantly higher than that of the group of allogeneichematopoietic stem cell transplantation(P value were both <0.05).(2) The EFS of the group of imatinib(CML in the accelerate and blast phase) was42.9%, and the OS was42.9%. The EFS of the group of allogeneic hematopoietic stem cell transplantation (CMLin the accelerate and blast phase) was47.6%, and the OS was57.1%. To compare the EFSand OS,there were no significant difference between the two groups.ConclusionsThe EFS and OS of the group of imatinib were significantly higher than that of thegroup of allogeneic hematopoietic stem cell transplantation for the patients of CML in thechronic phase. While there was no significant difference between the two groups for thepatients of CML in the accelerate and blast phase;but as with little cases,we need morepatients for further research for these two progress stage.