【摘要】 目的:评估第二代酪氨酸激酶抑制剂(TKI)达沙替尼、尼洛替尼与伊马替尼的疗效差异,探讨最佳临床选择。方法:对近3年在我院接受治疗的163例新诊断慢性髓系白血病(CML)慢性期患者(47例接受达沙替尼,43例接受尼洛替尼,73例接受伊马替尼治疗)的临床资料及随访结果进行分析,评价各时间节点治疗反应及疗效,评估不良事件。结果:达沙替尼组、尼洛替尼组、伊马替尼组治疗3个月完全血液学缓解(CHR)率分别为77%、79%和67%,12个月分别为92%、91%和90%。3组治疗3个月完全细胞遗传学缓解(CCyR)率分别为55%、53%和33%,而12个月分别为86%、88%和69%。3个月主要分子生物学缓解(MMR)率分别为11%、9%和1%,而12个月分别为49%、50%和28%。达沙替尼组2例(4%),尼洛替尼组2例(5%)出现疾病进展,而伊马替尼组6例(8%)出现疾病进展。达沙替尼、尼洛替尼及伊马替尼药物安全性未表现出显著差异。结论:第二代TKI达沙替尼及尼洛替尼可带来更快更深的缓解,从而获得更好的远期预后。更多还原

【Abstract】 Objective:To evaluate efficacy and safety of second-generation tyrosine kinase inhibitors(TKI)dasatinib,nilotinib and imatinib in treatment of newly diagnosed patients with chronic-phase chronic myeloid leukemia(CML).Methods:The clinical data and follow-up results of 163 patients with chronic-phase chronic myeloid lenkemia(CP-CML) who were treated in our hospital during the nearly 3 years were analysed retrospectively,among 163 patients47 received dasatinib,43 received nilotinib and 73 received imatinib.The efficacy,disease progression and safety were evaluated.Results:After treatment for 3 months,the rate of complete hematologic response(CHR) in three treatment groups were 77%,79%and 67%,respectivily,CHR at 12 months in three treatment groups were 92%,91%and90%,respectively.By 3 months,the rates of complete cytogenetic response(CCyR) with dasatinib and nilotinib were higher than that with imatinib(55%,53%vs 33%)(P < 0.05 for both comparisons),CCyR at 12 months in three treatment groups were 86%,88%vs 69%(P < 0.05 for both comparisons).The rates of major molecular response(M MR) for dasatinib(11%) and nilotinib(9%) by 3 months were significantly higher than that for imatinib(1%)(P<0.05 for both comparisons),MMR at 12 months in three treatment groups were 49%,50%and28%,respectively(P<0.05 for both comparison).Progression to the accelerated or blast phase of CML occurred in 2(4%) patients received dasatinib,2(5%) received nilotinib and 6(8%) received imatinib.The safety profiles of these 3 second-generation TKI treatments were similar.Conclusion:Both dasatinib and nilotinib induced strikingly higher and faster rates of complete cytogenetic response and major molecular response,with a statistically significant difference from imatinib.更多还原