慢性粒细胞白血病435例甲磺酸伊马替尼治疗后血液学不良反应

摘要

Objective To explore the hematology adverse reactions of imatinib mesylate (IM) in the treatment of chronic phase (CP) of chronic myeloid leukemia (CML).Methods The clinical data of 435 CML-CP patients treated with IM were analyzed respectively in the Affiliated Cancer Hospital of Zhengzhou University from Jan 2013 to Jan 2015.The hematology adverse reactions were followed up regularly and the incidences in different groups with various factors were compared.Results Until the end of follow-up,74 (17.0 ％) patients had hematology adverse reactions.61 (14.02 ％) patients had neutropenia,including 9 (14.75 ％) patients who had level Ⅲ-Ⅳ neutropenia.60 (13.79 ％) cases had thrombocytopenia including 11 (18.33 ％) patients with level Ⅲ-Ⅳ thrombocytopenia.Anemia occurred in 50 (11.49 ％) patients,of whom 5 (10.00 ％) cases were grade Ⅲ-Ⅳ anemia.33 (7.59 ％) cases experienced pancytopenia.The incidence of hematology adverse reactions was influenced by nine factors,including the course before treatment,the size of spleen,Sokal scores,the use of interferon,fusion genes,chromosomes,complete cytogenetic response,main molecular reaction and Karnofsky scores (all P ＜ 0.05),while it was not influenced by age,gender,BMI,smoking and drinking (all P ＞ 0.05).Conclusions During the initial treatment of CML-CP,if patients experienced level Ⅰ-Ⅱ hematology adverse reactions,they can continue to taking IM.However,when level Ⅲ-Ⅳ hematology adverse reactions happened,they need to reduce the dose or stop taking,and one month later,hemocyte will get well.In the long-term treatment of CML,once level Ⅲ-Ⅳ hematology adverse reactions occur,the patients need to receive some related inspections,such as bone marrow morphology and molecular biology detection,to clear the disease stage.When it is necessary,the patients can take the second generation of tyrosine kinase inhibitors.%目的 探讨甲磺酸伊马替尼(IM)治疗慢性粒细胞白血病(CML)慢性期患者的血液学不良反应发生情况.方法 回顾性分析郑州大学附属肿瘤医院2013年1月至2015年1月接受IM治疗的435例CML慢性期患者血液学不良反应的发生情况,比较不同临床病理因素分层患者血液学不良反应的发生率.结果 截至随访终点,435例慢性期患者中361例(83.0％)血象正常,74例(17.0％)发生血液学不良反应.61例(14.0％)出现中性粒细胞减少,其中Ⅲ、Ⅳ级9例(14.8％);60例(13.8％)出现血小板减少,其中Ⅲ、Ⅳ级11例(18.3％);50例(11.5％)出现贫血,其中Ⅲ、Ⅳ级5例(10.0％);33例(7.6％)出现全血细胞减少.血液学不良反应多发生于治疗后2～3周.对治疗前病程、脾脏大小、Sokal评分、是否使用干扰素、融合基因、染色体、是否获得完全细胞遗传学缓解、是否获得主要分子学反应、Karnofsky评分9个因素组内患者血液学不良反应发生率进行比较,差异均有统计学意义(均P＜0.05).年龄、性别、体质量指数(BMI)、是否吸烟喝酒4个因素组内患者血液学不良反应发生率比较,差异均无统计学意义(均P＞ 0.05).结论 如果IM治疗CML的初期发生Ⅰ、Ⅱ级血液学不良反应,可继续用药,若发生Ⅲ～Ⅳ级血液学不良反应时需减量或停药,患者血象在治疗4～6周后趋于稳定.在IM治疗CML后期出现严重血液学不良反应时,需进行骨髓形态学、分子生物学等相关检查,明确疾病分期,必要时可更换为二代酪氨酸激酶抑制剂.