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目的 研究格列卫 (STI 5 71)治疗慢性粒细胞白血病的疗效 ,探讨STI 5 71联合小剂量高三尖杉酯碱 (HHT)和阿糖胞苷 (Ara C)治疗时的疗效及其副作用的耐受性。方法 选自 2 0 0 1- 0 2 2 0 0 3- 0 8第一军医大学南方医院住院37例成年人患者的骨髓细胞Ph染色体阳性或FISH双标双融合bcr/abl基因异位探针 (FISH bcr/abl)阳性率均 >90 %。其中慢性粒细胞白血病慢性期 (CML CP) 14例 ,加速期 (CML AP) 5例 ,急变期 (CML BP) 18例 ,全部接受STI5 7每天 0 3～ 0 6g ,早晨空腹顿服 ,4例CML AP和全部CML BP患者联合HHT每天 12mg和Ara C每天 30 5 0mg静脉滴注 (VD) ,714d为 1疗程 ,疗程中位数 1 5个 ,STI 5 71治疗时间的中位数 2 5个月 ,治疗满 3个月者全部复查染色体和FISH bcr/abl。结果 CML CP和AP患者的HCR 10 0 % ,主要细胞遗传学反应率 84 3% ;18例CML BP患者的HCR 38 8% ,HPR 2 7 7% ,总有效率 6 6 5 % ,主要细胞遗传学反应率 10 5 % ,骨髓抑制 90 %。CML CP、AP患者的HCR和细胞遗传学主要反应率明显高于CML BP患者 ,P <0 0 1。结论 STI5 71治疗CML显示较高的HCR和细胞遗传学反应率 ,CML CP早期效果最好 ,CML BP患者疗效最差 ,与HA联合的毒性可以耐受
Objective To investigate the curative effect of Gleevec (STI 5 71) on chronic myeloid leukemia and to investigate the efficacy and side effects of STI 5 71 in combination with low dose of homoharringtonine (HHT) and cytarabine (Ara C) Tolerance. Methods were selected from 2 0 0 1- 0 2 2 0 0 3- 0 8 Ph chromosome-positive or FISH double-labeled bcr / abl heterotopic probe of marrow cells of 37 adult patients hospitalized in Nanfang Hospital, First Military Medical University FISH bcr / abl) positive rate of> 90%. Among them, there were 14 chronic myeloid leukemia (CML CP) chronic phase (CML CP), 5 accelerated phase (CML AP) and 18 acute phase (CML BP). All received STI5 7 0 ~ CML AP and all patients with CML BP combined with HHT 12mg daily and Ara C 305mg daily intravenous drip (VD), 714d for a course of treatment, the median of 15 courses, the median STI 5 71 treatment time 25 Month, the treatment of 3 months all review of chromosomes and FISH bcr / abl. Results HCR 10 0% and major cytogenetic response rate were 84 3% in CML CP and AP patients. HCR 38 8%, HPR 27 7% and total effective rate 6 6 5% of 18 CML BP patients were major cytogenetic The response rate of 105%, bone marrow suppression 90%. The main response rates of HCR and cytogenetics in CML CP and AP patients were significantly higher than those in CML BP patients (P <0.01). Conclusion STI5 71 treatment of CML showed a higher response rate of HCR and cytogenetic response, CML CP the best early effect, CML BP patients the worst efficacy, combined with HA toxicity can be tolerated