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1、·158·中华血液学杂志2004年3月第25卷第3期ChinJHematol,March2004,Vol25,No.3·论著·伊马替尼治疗Ph阳性慢性粒细胞白血病引起的骨髓形态学变化江倩陈珊珊江滨江浩史慧琳陆颖陆道培【摘要】目的观察伊马替尼治疗Ph阳性慢性粒细胞白血病(CML)引起的骨髓形态学变化,并探讨其与血液学、遗传学疗效之间的关系。方法117例Ph阳性CML患者,包括干扰素治疗失败的慢性期54例、加速期41例、急髓变期22例,日服伊马替尼400或600mg,持续18个月以上。结果治疗18个月内,各期患者骨髓增生程
2、度显著降低、原始粒细胞+早幼粒细胞显著减少、骨髓无CML特征的比例显著增加,慢性期和加速期患者粒、红细胞比例显著降低、巨核细胞数量显著减少(P值均<0105)。获得血液学疗效者骨髓形态持续正常。治疗中发生骨髓增生低下或极度低下还是增生活跃以上与血液学和遗传学疗效密切相关:慢性期患者其遗传学有效率分别为58.8%和86.5%(P=0.035),加速期患者血液学完全缓解率分别为26.3%和75.0%(P=0.004),急变期患者生存期短于6个月者比例分别为77.8%和16.7%(P=0.009)。在CML进展期,治疗1个月
3、时骨髓形态学无CML特征与有CML特征者相比,加速期患者18个月疾病进展率显著降低(分别为25.0%和75.0%,P=0.028)、总生存率显著升高(分别为75.0%和11.8%,P=0.004);急变期患者获得血液学效应的比例显著增加(分别为100.0%和40.0%,P=0.017)、总生存期长于半年者显著增多(分别为83.3%和26.7%,P=01046)。结论伊马替尼治疗有效的CML患者在持续用药下可维持持久的骨髓形态正常。【关键词】白血病,髓样,慢性;细胞形态学;伊马替尼Bonemarrowmorphologi
4、cfeaturesinpatientstreatedwithimatinibforPhiladelphiachromosomepositivechronicmyeloidleukemiaJIANGQian,CHENShan2shan,JIANGBin,JIANGHao,SHIHui2lin,LUYing,LUDao2pei.InstituteofHematology,PekingUniversity,People’Hospital,Beijing100044,China【Abstract】ObjectivesToass
5、essbonemarrowmorphologicchangesinPhiladelphia2chromosomepositive+chronicmyeloidleukemia(Ph2CML)patientstreatedwithImatinib,andtoevaluatethecorrelationofthemorpho2logicchangeswithhematologicalorcytogeneticresponses.MethodsOnehundredandseventeenpatientswith+PhCML:
6、54inchronicphasebutfailedtointerferon2alphatreatment,41inacceleratedphase,22inblasticphasereceivedoraladministrationofImatinib400or600mgoncedailyformorethan18months.ResultsAllofthepa2tientsrespondedtothetreatment,includingcompletehematologicalresponse,bonemarrow
7、responseandreturntochronicphase,bonemarrowcellularityandmyeloblastcountreducedsignificantlytonon2CMLpicture.MyeloidPerythroidratioandmegkaryocytecountweredecreasedsignificantlyinmostpatientsinchronicandacceleratedphas2es(P<0.05).Bonemarrowhypoplasiaoraplasiawasa
8、ssociatedwithlowercytogeneticresponseratesinpatientsinchronicphase(58.8%vs86.5%,P=0.035),lowercompletehematologicalresponseinpatientsinaccelerat2edphase(26.3%vs75.0%,
