文献标题：Long-term prognostic significance of early molecular response to imatinib in newly diagnosed chronic myeloid leukemia: an analysis from the International Randomized Study of Interferon and STI571 (IRIS)
文献出处：Blood,2010.11
期刊影响因子：10.555
文献类型:CLINICAL TRIALS AND OBSERVATIONS
这项研究应用干扰素和慢性髓样白血病(CML)患者的扩展数据集(STI571国际随机研究组织)调查取得早期分子学反应的预后意义。[Blood, 11 November 2010, Vol. 116, No. 19, pp. 3758-3765.]
一系列的分子学研究表明，随着时间的延长，BCR-ABL的转录水平下降。在第6、12、18个月时使用国际评分(international scale，IS),分析基于分子反应的无病生存 (event-free survival，EFS)和第7年时疾病进展至加速期/急变 (accelerated phase/blast crisis，AP/BC)的时间。与所有其他分子反应组相比，6个月时BCR-ABL转录＞10%和12个月时转录物＞1%患者的EFS差，进展至AP/BC的比率高。与之相反，18个月时取得主要分子学反应[MMR:BCR-ABL(IS)≤0.1%]的患者有着显著的持久缓解，第7年时的未进展到AP/BC，有着95%EFS。截至7年时，失去完全细胞遗传学反应的可能性，在18个月时MMR患者中仅为3%，在有完全细胞遗传学反应而非MMR患者中为26%（P＜0.001)。
该研究表明：治疗引起的BCR-ABL转录数量下降程度与长期临床预后强相关，支持应用时间依从性分子检测来确定最佳的治疗反应。
医脉通推荐英文摘要
Blood, 11 November 2010,Vol. 116, No. 19, pp. 3758-3765.
Long-term prognostic significance of early molecular response to imatinib in newly diagnosed chronic myeloid leukemia: an analysis from the International Randomized Study of Interferon and STI571 (IRIS).
Timothy P. Hughes
（Department of Haematology, SA Pathology, Royal Adelaide Hospital, Adelaide, Australia）
This study examines the prognostic significance of early molecular response using an expanded dataset in chronic myeloid leukemia patients enrolled in the International Randomized Study of Interferon and STI571 (IRIS). Serial molecular studies demonstrate decreases in BCR-ABL transcripts over time. Analyses of event-free survival (EFS) and time to progression to accelerated phase/blast crisis (AP/BC) at 7 years were based on molecular responses using the international scale (IS) at 6-, 12-, and 18-month landmarks. Patients with BCR-ABL transcripts > 10% at 6 months and > 1% at 12 months had inferior EFS and higher rate of progression to AP/BC compared with all other molecular response groups. Conversely, patients who achieved major molecular response [MMR: BCR-ABL (IS) 0.1%] by 18 months enjoyed remarkably durable responses, with no progression to AP/BC and 95% EFS at 7 years. The probability of loss of complete cytogenetic response by 7 years was only 3% for patients in MMR at 18 months versus 26% for patients with complete cytogenetic response but not MMR (P < .001). This study shows a strong association between the degree to which BCR-ABL transcript numbers are reduced by therapy and long-term clinical outcome, supporting the use of time-dependent molecular measures to determine optimal response to therapy.
文献来源
Timothy P. Hughes.Long-term prognostic significance of early molecular response to imatinib in newly diagnosed chronic myeloid leukemia: an analysis from the International Randomized Study of Interferon and STI571 (IRIS).Blood, 11 November 2010, Vol. 116, No. 19, pp. 3758-3765. [PubMed链接 | 期刊网站链接]
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