Clinical Research Of Children With Chronic Myelogenous Leukemia Treated With Targeted Therapy

Objective:Tyrosine kinase inhibitor(TKI)is the first choice of treatment for chroni myelogenous cleukemia(CML)patients.This study was designed to observe the efficacy and safety of TKI targeted therapy in children with chronic myelogenous leukemia in chronic phase.Methods:A total of 5 children diagnosed with CML in chronic phase in the Department of Hematology in Children's Hospital of Shanxi Province from January 1st 2014 to December 31st 2017 were selected.Among 5 cases,there were 1 male and 4 females,with a median age of 10(6?11)years.They were treated with imatinib 300mg/(m~2·d).The clinical manifestations of the children were observed regularly,and the changes of peripheral blood and molecular biological indexes were monitored to evaluate the curative effect,and the occurrence of adverse reactions during the treatment was recorded.Results:Complete hematological response(CHR)was obtained in 5 cases at 2.5,2,1.5,1.5and 2.5 months of targeted therapy,which was significantly different from the clinical reference standard(3 months)(t=-4.472,P=0.011<0.05).Among the 5 cases,4 patients attained major molecular response(MMR))at 9,9,12and 9 months after imatinib treatment.The quantitative detection of bcr-abl fusion gene was less than 0.1%.However,1 case of repeated intolerance imatinib within 2 months,and 4 months after the replacement of dasatinib the bcr-abl fusion gene quantitative test showed less than 1%,which was the best curative effect.MMR was also obtained after 9months of targeted therapy.The difference between this group of data and clinical MMR reference standard(12 months)was statistically significant(t=-4.000,P=0.016<0.05).The results of Pearson correlation analysis showed that there was no significant correlation between the time required to achieve CHR and the time required to achieve MMR after CML targeted therapy(r=-0.559,P=0.327>0.05).Among the 5 children treated with imatinib,2 cases had no obvious adverse reactions,1 had mild anemia,nausea,vomiting,anorexia and other gastrointestinal reactions,1 had thrombocytopenia,and 1 had bone marrow depression,that is to say,the blood corpuscle were significantly reduced,especially neutropenia,which decreased to 0in severe cases.Conclusion:Imatinib is effective in the early stage of children with CML in chronic phase with mild adverse reactions,good tolerance and safety..Dasatinib can make CML patients with intolerance to imatinib relieve at the level of hematology and molecular biology.It can be used as a second-line treatment option in the case of intolerance to imatinib.