目的 探讨伊马替尼和达沙替尼治疗初发慢性粒细胞白血病慢性期(CML-CP)的疗效.方法 选择2010年1月至2016年6月郑州大学附属洛阳中心医院诊断为CML-CP的初发患者40例,根据治疗方法将患者分为伊马替尼组(n=22)和达沙替尼组(n=18).伊马替尼组患者口服伊马替尼;达沙替尼组患者口服达沙替尼,2组患者均治疗1 a.评估2组患者治疗3、6个月的治疗反应、疗效及治疗12个月时不良反应发生情况.结果 伊马替尼组和达沙替尼组患者在治疗3个月时细胞遗传学达到"最佳疗效"的比例分别为45.5％(10/22)和55.6％(10/18),在治疗6个月时分别为36.4％(8/22)和38.9％(7/18);2组患者在治疗3个月时分子生物学达到"最佳疗效"的比例分为50.0％(11/22)和55.6％(10/18),治疗6个月时分别为31.8％(7/22)和38.9％(7/18);2组患者在治疗12个月时细胞遗传学治疗失败的比例分别为18.2％(4/22)和5.6％(1/18);2组患者在治疗12个月时分子生物学治疗失败的比例分别为18.2％(4/22)和5.6％(1/18).达沙替尼组患者治疗3、6个月时的细胞遗传学达到"最佳疗效"的比例、分子生物学达到"最佳疗效"的比例均高于伊马替尼组(P<0.05);达沙替尼组患者治疗12个月时细胞遗传学治疗失败的比例和分子生物学治疗失败的比例均低于伊马替尼组(P<0.05).伊马替尼和达沙替尼组患者BCR-ABL激酶区突变率分别为13.6％(3/22),5.6％(1/18);伊马替尼组患者BCR-ABL激酶区突变的发生率高于达沙替尼组(P<0.05).结论 与伊马替尼相比,达沙替尼治疗CML-CP具有更好的疗效,且BCR-ABL激酶区突变发生率低,适合在临床推广使用.%Objective To explore the efficacy of imatinib and dasatinib for treatment of newly diagnosed chronic my-elogenous leukemia chronic phase(CML-CP)patients. Methods Forty patients with CML-CP were selected in the Luoyang Central Hospital Affiliated to Zhengzhou University from January 2010 to June 2016. The patients were divided into imatinib group(n = 22)and dasatinib group(n = 18)according to the treatment method. The patients in imatinib group received ima-tinib orally for 1 year;the patients in dasatinib group received dasatinib orally for 1 year. The treatment response and curative effect of patients in the two groups were evaluated at 3,6 months after treatment;the aderverse reactions of patients in the two groups were evaluated at 12 months after treatment. Results The rate of optimal cytogenetic response of patients in imatinib group and dasatinib group was 45. 5％(10 / 22),55. 6％(10 / 18)at 3 months after treatment and 36. 4％(8 / 22),38. 9％(7 /18)at 6 months after treatment;the rate of optimal molecular response of patients in imatinib group and dasatinib group was 50. 0％(11 / 22),55. 6％(10 / 18)at 3 months after treatment and 31. 8％(7 / 22),38. 9％(7 / 18)at 6 months after treatment;the rate of failture to achieve a complete cytogenetic responses(CCyR)of patients in imatinib group and dasatinib group was 18. 2％(4 / 22),5. 6％(1 / 18)at 12 months after treatment;the rate of failure to achieve BCR-ABLIS≤1％ of patients in ima-tinib group and dasatinib group was 18. 2％(4 / 22),5. 6％(1 / 18)at 12 months after treatment. The rate of optimal cytogenetic response and optimal molecular response of patients in dasatinib group at 3,6 months after treatment were significantly higher than those in the imatinib group(P < 0. 05);the rate of failure to achieve a CCyR and BCR-ABLIS≤1％ of patients in dasat-inib group at 12 months after treatment were significantly lower than those in the imatinib group(P < 0. 05). The mutation rate of BCR-ABL kinase domain of patients in imatinib group and dasatinib group was 13. 6％(3 / 22)and 5. 6％(1 / 18)respective-ly;the mutation rate of BCR-ABL kinase domain of patients in imatinib group was significantly higher than that in the dasatinib group(P < 0. 05). Conclusion Compared with imatinib,dasatinib has better efficacy in treatment of CML-CP patients,and with lower mutation rate of BCR-ABL kinase domain. So,dasatinib is suitable for clinical use.
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