【摘要】 为了研究慢性粒细胞白血病 (CML)慢性期患者应用干扰素 α (IFN α)治疗后细胞遗传学疗效及其影响预后的因素 ,对我院 10年来 12 8例CML慢性期患者单用IFN α或联用化疗药物后细胞遗传学变化、核型演变及与临床有关特征的关系进行了回顾性分析。核型分析全部应用G 显带 ,部分联合应用荧光染色体原位杂交技术检测。结果表明 :①所有患者均获血液学缓解。② 118例Ph染色体标准易位患者中 36例 (30 .8% )获细胞遗传学反应 ,其中 2 0例 (17.1% )Ph染色体仍 >35 % ,13例 (11.1% )Ph染色体 <35 % ,3例 (2 5 % )Ph染色体为 0 ,达完全细胞遗传学缓解 ,细胞遗传学有效应者共 16例 (13.6 % )。③ 7例复杂变异易位患者中 4例获细胞遗传学反应 ,其中2例 (14 .3% )Ph染色体 >35 % ,2例 (14 .3% )Ph染色体 <35 % ,无 1例Ph染色体为 0 ;3例简单变异易位患者无 1例获细胞遗传学疗效。④IFN α治疗后影响细胞遗传学疗效的因素有 :性别、初诊病情、IFN α是否联用其他化疗药物及是否持续治疗。⑤IFN α治疗并不能防止CML疾病进展。结论 :①每周IFN α 6 0 0 - 90 0万U单用或联合Bu/Hu可使 11.1%的标准易位和少数复杂变异易位Ph+ CML患者获主要细胞遗传学效应 ,但不能防止疾病进展 ;②Ph变异易位并不预示IFN α疗效不佳 ;更多还原

【Abstract】 Ph chromosome occurs in nearly all patients with CML, and eliminating Ph positive clone is a major target in the treatment of CML. IFN α is a well known effective treatment in chronic phase CML. The cytogenetic response and the prognostic factors in 128 CML patients treated with IFN α were retrospectively studied. IFN α adminestered singly at a dose of 3 million U/day for 2-3 times a week or in combination with either hydroxyurea (Hu), busulfan (Bu), low dose Ara C or harringtonine. Karyotyping was examined by G banding before and after IFN α based treatment. The results showed that all patients achieved complete hematological remission. Cytogenetic response occurred in 36 of 118 patients with standard t(9;22) translocation; 3 of these 36 patients had a complete cytogenetic response (Ph=0), 13 had major cytogenetic responses (Ph<35%) and 20 had minmal response (Ph>35%). The total cytogenetic effectiveness was 13.6%(16/118). Four of seven patients with complicated variant translocation also achieved cytogenetic response, 2 of them had a major cytogenetic response and 2 had minmal response. Factors influenced the prognosis associated with cytogentic response included sex, patient status at diagnosis and IFN α administered singly or in combination with other chemotherapeutic agents. IFN α could not prevent the progression of CML. It is concluded that Ph +CML patients with both standard and variant translocation had major cytogenetic response to IFN α treatment at a dose of 6-9 million U/week in single or combination with Hu/Bu, however, IFN α treatment could not prevent disease progression. Long term suvival was also observed in patients with variant translocation treated with IFN α. Regular cytogenesis examination in CML patients is necessary during IFN α therapy, which is useful to reflect curative effect and progression of the disease.更多还原