继发恶性肿瘤的慢性髓性白血病患者接受 TKI 治疗后的预后

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继发恶性肿瘤的慢性髓性白血病患者接受 TKI 治疗后的预后

Title: THE OUTCOMES OF CHRONIC MYELOID LEUKEMIA PATIENTS WITH SECONDARY MALIGNANCIES UPON TKI TREATMENT

标题：继发恶性肿瘤的慢性髓系白血病患者接受 TKI 治疗后的预后

Type: Publication Only  类型：仅发表仅发表

Session title: Chronic myeloid leukemia - Clinical

分会标题：慢性髓系白血病--临床

Background: 

The outcomes of patients with chronic myeloid leukemia (CML) has been drastically improved by advent of tyrosine kinase inhibitors (TKIs). The life expectancy of CML patients with complete cytogenetic remission is approaching to that of general population. Consequently, attention has turned to long-term side effects, particularly development of de novo malignancies. 

酪氨酸激酶抑制剂（TKIs）的出现大大改善了慢性髓系白血病（CML）患者的治疗效果。细胞遗传学完全缓解的 CML 患者的预期寿命已接近普通人群。因此，人们开始关注长期副作用，尤其是新发恶性肿瘤的发生。

Methods:

Medical records of 139 CML patients diagnosed with secondary malignancies from 10 institutions of China were reviewed.

本文回顾了中国 10 家医疗机构的 139 名被诊断为继发性恶性肿瘤的 CML 患者的病历。

Results:

The median ages of all 139 patients at diagnosis of CML and the first secondary malignancy were 51 years (range, 13-88 years) and 53 years (range, 18-91 years), respectively. Male accounted for 54.7% (76/139). After a median follow-up of 85 months, the median time from diagnosis of CML to secondary malignancy was 49 months (range, 1-264 months). With regard to latency period of secondary malignancies, the use of two and more TKIs was a significantly risk factor in multivariate analysis (OR of 4.281, 95% CI 1.369-13.390, P = 0.012). Male (HR of 0.329, 95% CI 0.138-0.779, P = 0.012) and time ≤48 months between diagnosis of CML and secondary malignancies (HR of 0.183, 95% CI 0.076-0.443, P = 0.003) were each independent risk factors associated with worse overall survival. Unattained major molecular response at diagnosis of secondary malignancies (HR of 0.307, 95% CI 0.143-0.662, P = 0.003), male (HR of 3.640, 95% CI 1.485-8.925, P = 0.005), over 50 years old (HR of 2.373, 95% CI 1.008-5.585, P = 0.048) were identified as each independent risk factor associated with worse event-free survival.

所有 139 名患者确诊为 CML 和首次继发恶性肿瘤时的中位年龄分别为 51 岁（13-88 岁）和 53 岁（18-91 岁）。男性占 54.7%（76/139）。中位随访 85 个月后，从确诊 CML 到继发恶性肿瘤的中位时间为 49 个月（1-264 个月）。关于继发性恶性肿瘤的潜伏期，在多变量分析中，使用两种及两种以上 TKIs 是一个显著的风险因素（OR 为 4.281，95% CI 为 1.369-13.390，P = 0.012）。男性（HR 为 0.329，95% CI 为 0.138-0.779，P = 0.012）和 CML 诊断与继发性恶性肿瘤之间的间隔时间≤48 个月（HR 为 0.183，95% CI 为 0.076-0.443，P = 0.003）均是与总生存期缩短相关的独立危险因素。继发性恶性肿瘤诊断时未获得主要分子反应（HR 为 0.307，95% CI 为 0.143-0.662，P = 0.003）、男性（HR 为 3.640，95% CI 为 1.485-8.925，P = 0.005）、50 岁以上（HR 为 2.373，95% CI 为 1.008-5.585，P = 0.048）被确定为与无事件生存期较差相关的独立危险因素。

Summary/Conclusion: 

These results demonstrated that gender, the response to TKI as well as age, and the time from diagnosis of CML to secondary malignancy were the crucial factors for outcomes of CML patients with secondary malignancies.  

这些结果表明，性别、对 TKI 的反应、年龄以及从诊断为 CML 到继发恶性肿瘤的时间是影响 CML 患者继发恶性肿瘤预后的关键因素。