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目的:评价达沙替尼治疗伊马替尼耐药的BCR-ABL阳性慢性髓细胞白血病急变期(CML-BC)的疗效和安全性。方法:对7例伊马替尼耐药的CML-BC患者,给予达沙替尼100 mg/d口服治疗,观察达沙替尼对CML患者的血液学、遗传学及分子生物学反应,并监测不良反应,评估疗效和耐受情况。结果:7例伊马替尼耐药的BCR-ABL阳性CML-BC患者服用达沙替尼治疗后均获得完全血液学缓解,4例达到完全细胞遗传学缓解,1例达到完全分子学反应。4例达沙替尼治疗后检测到突变,4例死亡。2例出现3~4级中性粒细胞减少和3~4级血小板减少。结论:达沙替尼治疗伊马替尼耐药的BCR-ABL阳性CML-BC患者起效迅速,可获得完全血液学及细胞遗传学缓解,甚至获得完全分子生物学缓解,但维持时间短,容易再次出现疾病进展。达沙替尼治疗后可出现新的ABL激酶区突变,导致患者对达沙替尼耐药。
Objective: To evaluate the efficacy and safety of dasatinib in the treatment of imatinib-resistant BCR-ABL-positive chronic myeloid leukemia (CML-BC). Methods: Seven patients with imatinib-resistant CML-BC were treated with dasatinib 100 mg / d orally, and the hematological, genetic and molecular biological responses to dasatinib in CML patients were observed Monitor adverse reactions, assess efficacy and tolerability. RESULTS: Seven patients with imatinib-resistant BCR-ABL-positive CML-BC achieved complete hematologic response after treatment with dasatinib, four achieved complete cytogenetic response and one achieved complete molecular response. Four patients were treated with dasatinib and mutations were detected. Four patients died. There were 3 to 4 neutropenia and 3 to 4 thrombocytopenia in 2 patients. CONCLUSIONS: Dasatinib treatment of imatinib-resistant BCR-ABL-positive CML-BC patients developed rapid onset of complete hematological and cytogenetic response and achieved complete molecular biological response but maintained a short time, Easy to re-emergence of disease progression. Dasatinib treatment can occur after a new ABL kinase mutation, resulting in patients resistant to dasatinib.