The Efficacy Analysis Of Lmatinib To The Chronic Myeloid Leukemia

The efficacy analysis of Imatinib to the chronic myeloid leukemiaChronic myeloid leukemia (CML) is a clonal myeloproliferative disease characterized by leukocytosis, splenomegaly and the Philadelphia (Ph) chromosome genetic abnormality or The BCR-ABL fusion gene. The morbidity is about 1-2 per 100,000 population per year, with a peak age of 45 to 55-year-old, male to female ratio is about 2:1.Natural course of the disease lasts 3-5 years. The clinical course can be divided into three phases:chronic phase, accelerated phase, blast phase, the median phase is 3-4 years,6-9 months,3-6 months respectively. The traditional treatment drugs such as busulfan, hydroxyurea, interferon didn't prolong the survival in patients with CML. Allogeneic hematopoietic stem cell transplantation is the only curative therapy for CML, but lack of the donors and transplant-related death risk limits its application. Tyrosine kinase inhibitors-imatinib mesylate, the crucial step of the CML treatment history, prolong the survival successfully. But about 35% of patients with CML-CP become resistant to imatinib or cannot tolerate the drug. Therefore, in the current imatinib resistance becomes a major theme in clinical trials.Method:This study retrospectively analyzed 231CML patients newly diagnosised in our hospital from January,2005 to April,2011. We monitored the patients' blood cell count,the morphology of bone marrow,Ph chromosome and BCR/ABL fusion gene to evaluate the efficacy of treatment. We use the software Microsoft Office Excel to set up the database and use the SPSS17.0 system to analyze the data andχ2 test to compare the data of every group.Result:1,male patients are more than female patients, with a 1.48:1 ratio.The peak age is 35 to 45-year-old, and the median age is 42-year-old。At diagnosed,82.25% of patients are at CP.2,Comparison of the efficacy between two treatment groups:Imatinib treatment group had got higher rate in the CHR, PCyR, CCyR, CMR,5-year OS than Non-Imatinib treatment group (P<0.001).3,Adverse reaction:The common adverse reaction of imatinib was edema, about 58.21%.4. Compared with late chronic phase, AP and BP, the early chronic phase had higher rate in the CHR, PCyR, CCyR, CMR (P<0.0083).5,There had not significant difference in the CHR between the three risk groups, low-risk group got higher rate in the CHR, PCyR, CCyR, CMR,2-5 year OS (P<0.017).6,In 33 cases who accepted the ASS mutation test,7 cases (21.21%) were found. Imatinib treatment group contained three cases, these three patients all showed primary imatinib resistant.7,b3a2 accounted for 76%, b2a2 accounted for 24%, There were no significant differences in the distribution of b2a2, b3a2 in the different clinical phases.8,The early CP Imatinib treatment group got lower imatinib resistant rate than other phases (P<0.05). In 28 resistant cases who accepted the ABL kinase domain mutation test,6 cases were found, contained Y253H 2 cases, H396R 1 case, E450G 1 case,G259E 1例, E255V 1例, respectively.1 case among 8 resistant cases got low blood drug concentration.13.04% cases got a new additional type of chromosome change.Conclusion:1,The median age of CML patients in the study are lower than the Western countries, the but the patients became more younger.2,Imatinib group got the higher rate of CHR,CCR,MMR and OS than the other groups, and was well tolerated. It is first-line treatment t for CML.3,The early CP patients treatmented with the imatinib got the higher remission rate than the late CP, AP and BP patients, Recommend to start imatinib therapy as soon as possible.4. Sokal score and the Hasford score in CML can still be used for predicting the efficacy.5.ASS indicates poor prognosis.6. b3a2 accounted for 76%, b2a2 accounted for 24%, There were no significant differences in the distribution of b2a2, b3a2 in the different clinical phases.5. The early CP in the imatinib treatment group got lower imatinib resistant rate than other phases. The mechanisms of imatinib resistance contained ABL kinase domain mutation,low blood drug concentration,a new additional type of chromosome change.