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背景与目的:慢性髓细胞白血病急性髓性变后,治疗非常困难,预后极差。本文旨在探讨特异性BCR/ABL酪氨酸激酶抑制剂(甲磺酸马替尼,格列卫)治疗慢性髓细胞白血病急性髓性变的疗效。方法:甲磺酸马替尼治疗组19例与历史对照组22例均先用含阿糖胞苷的标准化疗方案诱导治疗2疗程后,治疗组用甲磺酸马替尼400mg/d继续巩固或诱导治疗,治疗4周如无效,则将剂量增加至600mg/d,继续治疗8周;如有效,则用该剂量继续维持,仍无效则停用。历史对照组则采用其他方案继续巩固或诱导治疗。结果:治疗组标准诱导治疗无效的16例患者用甲磺酸马替尼治疗,6例(38%)取得完全的血液学缓解,获大部分遗传学效应;2例(13%)获部分血液学缓解,1例(6%)回到慢性期,获小部分遗传学效应;总的血液学有效率为56%。存活1年者6例(38%)。对照组诱导治疗无效的18例患者采用其他方案诱导化疗,仅2例(11%)取得完全的血液学缓解;1例(6%)获部分血液学缓解,总有效率为17%;1年内存活者仅1例(6%)。两组比较,差异有显著性(P<0.05)。结论:甲磺酸马替尼治疗慢性髓细胞白血病急性髓性变疗效高、生存时间延长,且耐受性好。但仍存在复发和耐药问题。
BACKGROUND AND AIM: Chronic myeloid leukemia after acute myelogenous degeneration, the treatment is very difficult, the prognosis is very poor. This article aims to investigate the efficacy of a specific BCR / ABL tyrosine kinase inhibitor (matinib mesylate, Gleevec) in the treatment of acute myeloid leukemia in patients with chronic myelogenous leukemia. Methods: Nineteen patients in the treatment group of matinib and 22 patients in the control group were treated with standard chemotherapy containing cytarabine. After two courses of treatment, the patients in the treatment group were continuously treated with 400 mg / Or induction therapy, 4 weeks if the treatment is invalid, the dose will be increased to 600mg / d, to continue treatment for 8 weeks; if effective, then continue with the dose to maintain, still inactive disabled. The historical control group is using other programs to continue to consolidate or induce treatment. RESULTS: Sixteen patients who were treated with standard induction therapy in the treatment group were treated with mesylate mesylate, six patients (38%) achieved complete hematologic response and gained most of the genetic effects; two (13%) received partial blood Learning amelioration, 1 patient (6%) returned to the chronic phase with minor genetic effects; the overall hematologic response rate was 56%. 6 survived for 1 year (38%). In the control group, 18 patients who were ineffective in induction therapy received induction chemotherapy with other regimens and only 2 patients (11%) achieved complete hematological response. One patient (6%) received partial hematologic remission with a total effective rate of 17% Only 1 survivor (6%). The difference between the two groups was significant (P <0.05). Conclusion: The treatment of chronic myeloid leukemia with acute myelogenous letrozole has a high therapeutic effect, prolonged survival and good tolerability. But there are still recurrence and drug resistance problems.