Prognostic significance of cytogenetic clonal evolution in patients with chronic myelogenous leukemia on imatinib mesylate therapy
Prognostic significance of cytogenetic clonal evolution in patients with chronic myelogenous leukemia on imatinib mesylate therapy
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DOI：
10.1182/blood-2002-09-2790
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发表时间：
2003-05-15
期刊：
影响因子：
20.3
通讯作者：
Kantarjian, HM
中科院分区：
文献类型：
--
作者：
Cortes, JE;Talpaz, M;Kantarjian, HM
细胞遗传学克隆进化（CE）是费城染色体阳性慢性髓细胞性白血病（Ph阳性CML）的一个已知不良预后因素。然而，其在伊马替尼治疗时代的预后相关性尚不清楚。我们研究了498例接受伊马替尼治疗的慢性期或加速期Ph阳性CML患者CE的独立预后相关性。121例患者接受了单独CE（n = 70）或其他加速期标准（n = 51）。比较了4类患者：慢性期（n = 295）、仅CE（n = 70）、加速期无CE（n = 92）和加速期有CE（n = 51）。统计学方法使用已建立的单变量和多变量分析方法。在慢性期和加速期CML中，CE与主要或完全细胞遗传学缓解率的显著差异无关，但在慢性期（P = 0.005）和加速期（P = 0.03），CE是生存的独立不良预后因素。在3个月里程碑（包括3个月细胞遗传学缓解）时进行的多变量分析发现，3个月时缺乏细胞遗传学缓解是比CE更强的独立生存不良预后因素，无论是慢性（主要细胞遗传学缓解vs其他缓解）还是。加速期（任何细胞遗传学缓解与其他缓解相比）。我们的结论是，细胞遗传学CE不是一个重要的因素，实现重大或完全的细胞遗传学反应与伊马替尼甲磺酸盐治疗，但它是一个独立的预后不良因素的生存在慢性和加速阶段的CML。对甲磺酸伊马替尼治疗的3个月细胞遗传学缓解改善了此类研究在甲磺酸伊马替尼治疗患者中的预后相关性。(C)2003年，美国血液学会。
Cytogenetic clonal evolution (CE) is a known poor prognostic factor in Philadelphia chromosome-positive chronic myelogenous leukemia (Ph-positive CM L). However, its prognostic relevance in the era of imatinib therapy is unknown. We investigated the independent prognostic relevance of CE in 498 patients with Ph-positive CML treated with imatinib for chronic or accelerated phases. One hundred twenty-one patients had, CE alone (n = 70) or with other accelerated phase criteria (n = 51). Patients were compared in 4 categories: chronic phase (n = 295), CE only (n = 70), accelerated phase without CE (n = 92), and accelerated phase with CE (n = 51). Statistical methods used established methodologies for univariate and multivariate analyses. in chronic and accelerated phases, of CML, CE was not associated with significant differences in major or complete cytogenetic response rates, but it was an independent poor prognostic factor for survival by multivariate analyses in both chronic (P = .005) and accelerated phase (P = .03). Multivariate analyses conducted at the 3-month landmark (including the 3-month cytogenetic response) identified the lack of cytogenetic response at 3 months to be a stronger independent poor prognostic factor for survival than CE for both chronic (major cytogenetic response versus other) and. accelerated phase (any cytogenetic response versus other). We conclude that cytogenetic CE is not an important factor for achieving major or complete cytogenetic response with imatinib mesylate therapy, but it is an independent poor prognostic factor for survival in both chronic and accelerated phases of CML. The 3-month cytogenetic response to imatinib mesylate refined the prognostic relevance of such studies in patients, on imatinib mesylate therapy. (C) 2003 by The American Society of Hematology.