索拉非尼对FMS样酪氨酸激酶3-基因内部串联重复突变急性髓系白血病患者的疗效观察

Sorafenib in treatment of acute myeloid leukemia patients with Fms-like tyrosine kinase 3-internal tandem duplication mutation

  • 摘要: 目的 分析索拉非尼对携带FMS样酪氨酸激酶3-内部串联重复突变(Fms-like tyrosine kinase 3-internal tandem duplication mutation,FLT3-ITD)急性髓系白血病(acute myeloid leukemia,AML)患者的疗效和安全性。方法 回顾性分析2012年1月-2018年4月解放军总医院第一医学中心收治的连续的初治FLT3-ITD阳性AML患者(M3型除外),第1疗程诱导化疗中未应用索拉非尼并且1个疗程结束后未缓解,共计42例。根据患者后续治疗是否应用索拉非尼分为索拉非尼观察组和无索拉非尼对照组,比较两组化疗后的完全缓解率(complete remission,CR)、总生存率(overall survival,OS)及无复发生存(relapse-free survival,RFS),并评估不良事件。结果 观察组15例,对照组27例,两组基线资料差异无统计学意义(P>0.05)。观察组与对照组的完全缓解率分别为73.3%、40.7%,差异有统计学意义(P=0.043)。观察组1年总生存率及1年无复发生存率均高于对照组(1年总生存率:53.3% vs 25.9%;1年无复发生存率:54.5% vs 18.2%),但差异无统计学意义(P>0.05)。两组不良反应的类型及发生率差异无统计学意义(P>0.05)。结论 索拉非尼安全性较好,可以改善FLT3-ITD阳性急性髓系白血病患者完全缓解率,为患者异基因造血干细胞移植争取时机。

     

    Abstract: Objective To analyze the effect and safety of sorafenib in treatment of acute myeloid leukemia (AML) patients carrying Fms-like tyrosine kinase 3-internal tandem duplication (FLT3-ITD) mutation. Methods From January 2012 to April 2018,42 AML patients with FLT3-ITD who did not receive sorafenib treatment and did not achieve complete remission in the first induction chemotherapy in our center were included in this study.According to the presence or absence of sorafenib in the following treatment regime,the patients were divided into observation group (treated with sorafenib) and control group (treated without sorafenib).The complete remission (CR) rate,overall survival (OS) and relapse-free survival (RFS) were compared after chemotherapy between the two groups and the adverse events were assessed. Results There were 15 patients in the observation group and 27 patients in the control group.No significant difference was found in the general data and clinical features between the two groups (P>0.05).The complete remission rate of the observation group and the control group were 73.3% and 40.7%,respectively,and the difference was statistically significant (P=0.043).The 1-year OS and 1-year RFS of the observation group were higher than those of the control group (1-year OS:53.3% vs 25.9%;1-year RFS:54.5% vs 18.2%),without statistically significant difference (P>0.05).There was no significant difference in the types and incidence of adverse events between the two groups. Conclusion Application of sorafenib is safe and effective for patients with FLT3-ITD-positive acute myeloid leukemia.It can improve the complete remission rate,thus providing the opportunity for allogeneic hematopoietic stem cell transplantation.

     

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