Comparison of clinical efficacy between first-generation and second-generation tyrosine kinase inhibitors based regimen in the treatment of patients with BCR-ABL positive acute lymphoblastic leukemia
10.3760/cma.j.issn.0253-2727.2019.09.005
- VernacularTitle: 一代与二代酪氨酸激酶抑制剂为基础的方案治疗BCR-ABL阳性急性淋巴细胞白血病疗效比较
- Author:
Ying LIU
1
;
Ruihua MI
;
Lin CHEN
;
Fangfang YUAN
;
Qingsong YIN
;
Yuewen FU
;
Xinghu ZHU
;
Xinjian LIU
;
Yanli ZHANG
;
Wenlin ZHANG
;
Xudong WEI
Author Information
1. Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University, Henan Provincial Tumor Hospital, Zhengzhou 450008, China
- Publication Type:Journal Article
- Keywords:
Leukemia, lymphoblastic, acute;
Tyrosine kinase inhibitor;
BCR-ABL positive
- From:
Chinese Journal of Hematology
2019;40(9):738-743
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the clinical efficacy and prognostic factors of first-generation and second-generation tyrosine kinase inhibitors (TKI) based regimen in the treatment of patients with BCR-ABL positive acute lymphoblastic leukemia (ALL) .
Methods:Retrospectively analyze the clinical characteristics and prognostic factors of 89 patients with BCR-ABL positive ALL from April 2012 to June 2018 in our hospital, the clinical efficacy of first-generation and second-generation TKI was compared.
Results:60 patients were classified into the first-generation TKI (imatinib) group, and 29 patients were in the second-generation TKI (dasatinib) group. There were no significant differences in gender, age, WBC, hemoglobin concentration, PLT, chromosomal karyotype, the types of fusion genes, allogeneic hematopoietic stem cell transplantation (allo-HSCT) and TKI initiation time between the two groups. The first-generation and second-generation TKI groups, for which the complete remission (CR) rate at the fourth week of induction therapy was 83.3% and 89.7% (P=0.637) , respectively, and the complete molecular remission (CMR) was 48.3%and 58.6% (P=0.363) , respectively, the difference was not statistically significant. The 2-year overall survival (OS) rate of first-generation and second-generation TKI group was 34.9% and 64.0% (χ2=4.743, P=0.029) , the 2-year relapse free survival (RFS) rate was 17.2% and 55.0% (χ2=8.801, P=0.003) , respectively. Multivariate analysis showed that complete molecular remission (HR=0.281, 95%CI 0.151-0.523, P<0.001) was independent favorable prognostic factor for overall survival (OS) , complete molecular remission (HR=0.209, 95%CI 0.112-0.390, P<0.001) and second-generation TKI (HR=0.318, 95%CI 0.158-0.641, P=0.001) were independent favorable prognostic factors for RFS.
Conclusion:For TKI-based regimen of BCR-ABL positive ALL, second-generation TKI is superior to first-generation TKI in OS and RFS time.
