酪氨酸激酶抑制剂治疗慢性粒细胞白血病的模式：来自中国的单中心数据。

IF 2.7 4区医学 Q2 HEMATOLOGY

Clinical Lymphoma, Myeloma & Leukemia Pub Date : 2024-12-24 DOI:10.1016/j.clml.2024.12.008

Meng-yao Yuan , Xiao-shuai Zhang , Qian Jiang

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引用次数: 0

摘要

目的：描述中国某中心慢性髓性白血病（CML）患者酪氨酸激酶抑制剂（TKI）的治疗模式并分析TKI转换的协变量。方法：回顾性分析CP-CML患者TKI转换模式、原因及相关协变量。结果：回顾性调查了1766例最初接受伊马替尼（n = 1374）、尼洛替尼（n = 254）、达沙替尼（n = 63）和氟马替尼（n = 75）治疗的患者。中位随访时间为48 （IQR, 24-77）个月。一线TKI切换比例为32%(570/1766)，二线为36%(208/570)，三线为34%（71/208）。常见的治疗顺序包括伊马替尼-达沙替尼（37%）或尼洛替尼（35%），伊马替尼-尼洛替尼-达沙替尼（25%）联合2个开关，伊马替尼-尼洛替尼-达沙替尼-olverembatinib（18%）联合3个开关。TKI切换主要是由于抗性（跨系64%、76%、88%）和不耐性（19%、14%、7%）。多变量分析显示，ELTS中/高危组（相对于低危组）、男性和低血红蛋白与TKI切换的高概率显著相关。与伊马替尼相比，最初的尼罗替尼或达沙替尼的转换率较低。男性和ELTS高风险（相对于低/中等）与耐药性相关切换相关，而较低的血红蛋白、年龄较大和初始达沙替尼或氟马替尼（相对于伊马替尼）与不耐受相关切换到二线治疗相关。二线伊马替尼/氟马替尼（vs.尼洛替尼/达沙替尼）和无/非特异性ABL突变与转向三线治疗的耐药性相关。结论：这些发现强调了CP-CML患者管理的复杂性，并强调了个性化治疗策略的重要性。

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Tyrosine Kinase Inhibitor Treatment Patterns in Patients With Chronic-Phase Chronic Myeloid Leukemia: A Single Center Data From China

Aim

To describe tyrosine kinase inhibitor (TKI) treatment patterns and analyze co-variates of TKI switch for chronic myeloid leukemia (CML) patients in a center from China.

Methods

A retrospectively study was designed to analyze TKI switching patterns, reasons and associated covariates in patients with CP-CML.

Results

1766 patients receiving initial imatinib (n = 1374), nilotinib (n = 254), dasatinib (n = 63) and flumatinib (n = 75) therapy were retrospectively interrogated. Median follow-up was 48 (IQR, 24-77) months. TKI switch proportions were 32% (570/1766) for first-line, 36% (208/570) for second-line and 34% (71/208) for third-line. Common therapy sequences included imatinib-dasatinib (37%) or nilotinib (35%) in those with 1 switch, imatinib-nilotinib-dasatinib (25%) with 2 switches and imatinib-nilotinib-dasatinib-olverembatinib (18%) with 3 switches. TKI switches were mainly due to resistance (64%, 76%, 88% across lines) and intolerance (19%, 14%, 7%). Multivariable analyses revealed ELTS intermediate/high-risk group (vs. low-risk), male, and lower hemoglobin were significantly associated with a higher probability of TKI switch. Compared to imatinib, initial nilotinib or dasatinib had lower switch rates. Male and ELTS high-risk (vs. low/intermediate) were associated with resistance-related switches, while lower hemoglobin, older age and initial dasatinib or flumatinib (vs. imatinib) were associated with intolerance-related switches to second-line therapy. Second-line imatinib/flumatinib (vs. nilotinib/dasatinib) and no/nonspecific ABL mutation were associated with resistance-related switches to third-line therapy.

Conclusion

These findings emphasized the complexities involved in the management of patients with CP-CML and highlighted the importance of personalized treatment strategies.

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来源期刊

Clinical Lymphoma, Myeloma & Leukemia ONCOLOGY-HEMATOLOGY

CiteScore

2.70

自引率

3.70%

发文量

1606

审稿时长

26 days

期刊介绍： Clinical Lymphoma, Myeloma & Leukemia is a peer-reviewed monthly journal that publishes original articles describing various aspects of clinical and translational research of lymphoma, myeloma and leukemia. Clinical Lymphoma, Myeloma & Leukemia is devoted to articles on detection, diagnosis, prevention, and treatment of lymphoma, myeloma, leukemia and related disorders including macroglobulinemia, amyloidosis, and plasma-cell dyscrasias. The main emphasis is on recent scientific developments in all areas related to lymphoma, myeloma and leukemia. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.