The Therapeutic Effect Analysis Of Tyrosine Kinase Inhibitor And Chemotherapy Combined Treatment To Chronic Myelogenous Leukemia In Blastic Phase Patients

Objective:To compare the differences of therapeutic effect, survival time and adverse reaction between the tyrosine kinase inhibitor(TKI) and the chemotherapy combined treatment to the chronic myelogenous leukemia in blastic phase(CML-BP) patients.Methods:To retrospective analysis the fifty-one patients from 2007.1 to 2015.1 which diagnosed to be CML-BP patients in the Hematology Department of the First Affiliated Hospital Of Nanhua University, according to the different treatment methods the fifty-one patients were divided into three group,the only chemotherapy group, the TKI group and the TKI combine chemotherapy group.To compare the impact of this three different treatment according to the hemogram, bone marrow morphology, cytogenetics and molecular biology,and to evaluate the therapeutic effect and adverse reactions in this three group.Results:1.The fifty-one patients median follow-up time was 6.5 months,the hematology total effective rate was 41.1%,the complete hematologic remission(CHR) rate was 31.3%,the return chronic phase(RCP) rate was 19.6%,the major cytogenetic remission(MCy R) rate was 15.6% and the complete cytogenetic remission(CCy R) rate was 7.8%.2.The hematology total effective rate of the three group: the only chemotherapy group, the TKI group, the TKI combine chemotherapy group were 35.2%: 50%:81.8% respectively, it is showed a significant statistical differences(p=0.009), which it is showed a significant statistical differences on the total effective rate between The chemotherapy only group with The TKI group(p =0.006) and the TKI combine chemotherapy group(p =0.014), but there is no statistical differences on the total effective rate between the TKI group and the TKI combine chemotherapy group(p =0.463). The respectively CHR rate were 17.6%:33.3%:40.9%, p= 0.318; the respectively RCP rate were 11.7% :16.6% : 27.2%, p= 0.548; the respectively MCy R rate were 5.8% : 16.6% : 31.8%, p=0.426; the respectively CCy R rate were 0% : 8.3% : 13.6%, p=0.339;it is not showed an obviously statistical differences in the aspects of CHR, RCP, MCy R, CCy R in these three groups(p>0.05).3.The median Progression-free survival(PFS) time of the fifty-one patients were 4 months, the median overall survival(OS) time were 7 months. The respectively median PFS time of the only chemotherapy group, the TKI group and the TKI combine chemotherapy group were 1 months, 5 months and 6 months, p= 0.043; which it is showed a significant statistical differences on PFS between the only chemotherapy group with The TKI group(p=0.049)and The TKI combine chemotherapy group( p=0.012), but there is no statistical differences on PFS between The TKI group and The TKI combine chemotherapy group. The respectively median OS time were 2 months, 8 months and 10 months, p=0.003; which it is showed a significant statistical differences between the only chemotherapy group with the TKI group(p =0.033)and The TKI combine chemotherapy group(p =0.001), but there is no statistical differences between the TKI group and the TKI combine chemotherapy group(p =0.303). The three group showed the obviously statistical differences in the aspects of PFS and OS(p<0.05).4. The aspect of adverse effect: the total incidence of infection rate of the three groups is 64.7%.The respectively incidence of infection rate in the only chemotherapy group, the TKI group and the TKI combine chemotherapy group were 76.4%:25%:77.2%(p =0.004), the only chemotherapy group and the chemotherapy combine TKI group showed a significant higher infection rate.In the theatment period,the respectively rate of drug-related serious adverse effect of these three groups patients were 11.7%:0%:4.5%(p =0.596).The three groups patients all showed 3-4 grades hematology and no-hematology adverse reactions, and tolerated well.5.The COX single factor analysis to the fifty-one patients reveal that the CML-BP treatment,obtain CHR,CCy R and MMR is the influence factor of OS ?10 months.COX multi-factor analysis reveal that obtain CHR is the independent influence factor of OS?10 months,and both a favorable prognostic factor.Conclusion:1.The CML-BP patients which been added TKI in treatment showed a higher effective rate, longer PFS and OS than the patients which just chemotherapy treatment only,and the adverse reaction of the patients which TKI treatment only were more light and more easy tolerated compare to the other two groups.2. Achieved the CHR was the favorable prognostic factor for the patients to have longer survival time.