文章：

伊马替尼治疗的慢性髓性白血病患者早期BCR-ABL1下降：来自中国CML联盟多中心研究的结果

Early BCR-ABL1 decline in imatinib-treated patients with chronic myeloid leukemia: results from a multicenter study of the Chinese CML alliance

原文发布日期：2018-06-15

DOI: 10.1038/s41408-018-0093-4

类型: Article

开放获取: 是

英文摘要：

An early molecular response is spectacularly predictive of outcome in chronic myeloid leukemia (CML) and early response landmarks may identify the high-risk patients likely to be benefit from an early therapy switch. In this study, we evaluated the most relevant cutoffs for early molecular response markers (BCR-ABL1 values at 3 months, log reduction and halving time between diagnosis and 3 months) in 476 first-line imatinib-treated Chinese patients with chronic phase CML. All outcomes were significantly superior for the 324 patients with 3-month BCR-ABL1 ≤10%, so did for the 270 patients with BCR-ABL1 >0.61 log reduction. BCR-ABL1 halving time ≤22 days was identified for patients with the most favorable outcome. Moreover, the prognosis was significantly poorest for patients with both halving time >44 days and BCR-ABL1 >10%. Importantly, multivariate regression analysis demonstrated that a BCR-ABL1 log reduction calculated at 3 months of 0.61 was the only variable that significantly predicted for OS. Our results highlight the importance of rapid initial decline of BCR-ABL1 in predicting satisfactory outcome. Our data support the evidence that monitoring BCR-ABL1 values at an early time point could contribute to accurately assess response and ultimately guide clinical decisions regarding the timing of therapeutic intervention.

摘要翻译： 

早期分子学反应对慢性髓系白血病（CML）的预后具有显著预测作用，早期反应标志物或可识别可能从早期治疗转换中获益的高危患者。本研究针对476例接受伊马替尼一线治疗的中国慢性期CML患者，评估了早期分子学反应标志物（3个月时BCR-ABL1值、对数降幅及诊断至3个月间的减半时间）的最相关临界值。在324例3个月BCR-ABL1≤10%的患者中，所有结局指标均显著更优；270例BCR-ABL1对数降幅>0.61的患者结果亦然。BCR-ABL1减半时间≤22天的患者被确认具有最佳预后。此外，同时存在减半时间>44天和BCR-ABL1>10%的患者预后最为不良。重要的是，多元回归分析表明，3个月时计算的BCR-ABL1对数降幅0.61是显著预测总生存期的唯一变量。我们的结果突显了BCR-ABL1初始快速下降对预测满意结局的重要性。本研究支持以下证据：早期监测BCR-ABL1值有助于准确评估治疗反应，并最终指导治疗干预时机的临床决策。

原文链接：

Early BCR-ABL1 decline in imatinib-treated patients with chronic myeloid leukemia: results from a multicenter study of the Chinese CML alliance