RESUMO
AIM: To reveal prognostically significant factors affecting efficacy of glivek therapy in untreated (duration of the disease < or = 6 months) and pretreated (duration of the disease > 6 months) patients with chronic myeloid leukemia (CML) in a chronic phase. MATERIAL AND METHODS: A total of 338 patients (64 untreated and 274 pretreated) with a chronic-phase CML on glivek therapy entered the trial. RESULTS: Five-year survival on glivek was high (89, 98 and 88% in untreated and pretreated patients, respectively). Incidence of transformation in the acceleration phase and blast crisis was low both in untreated and pretreated patients (1.6 and 11%, respectively) and correlated with the rate of a complete cytogenetic response (CCR). Untreated patients had no factors affecting treatment efficacy negatively, CCR probability was 96%. Blastemia, thrombocytosis and splenomegaly reduced CCR probability significantly in pretreated patients. Slow reduction of the tumor mass, late achievement of a complete hematological response and a cytogenetic response decreased probability of CCR. CONCLUSION: Glivek is a drug of choice for patients with chronic-phase CML. High probability of CCR both in untreated and pretreated patients lowers the risk of the disease transformation into the phase of acceleration/blast crisis and raises overall survival in both groups.
Assuntos
Antineoplásicos/uso terapêutico , Leucemia Mieloide de Fase Crônica/tratamento farmacológico , Piperazinas/uso terapêutico , Pirimidinas/uso terapêutico , Adolescente , Adulto , Idoso , Benzamidas , Crise Blástica/epidemiologia , Crise Blástica/patologia , Progressão da Doença , Feminino , Seguimentos , Hematopoese/efeitos dos fármacos , Humanos , Mesilato de Imatinib , Incidência , Leucemia Mieloide de Fase Crônica/mortalidade , Leucemia Mieloide de Fase Crônica/patologia , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Prognóstico , Proteínas Tirosina Quinases/antagonistas & inibidores , Fatores de Risco , Federação Russa/epidemiologia , Taxa de Sobrevida/tendências , Fatores de TempoRESUMO
Chronic myeloid leukemia (CML) is a hemopoietic condition caused by chromosomal translocation t(9;22)(q34;q11) or bcr-abl fusion gene. The predominant variants of bcr-abl oncogene rearrangement are b3a2 and b2a2. The present study evaluated the efficacy of interferon-a therapy of CML patients and molecular prognostic factors. Cytogenetic response and complete hematological remission were more frequent in CML b3a2 treatment with interferon-a. Moreover, after therapy, chronic phase lasted in that group (p = 0.026) much longer. Overall survival in the group was significantly longer, too (p = 0.046).
Assuntos
Antineoplásicos/uso terapêutico , Interferon-alfa/uso terapêutico , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Biomarcadores Tumorais/metabolismo , Humanos , Leucemia Mielogênica Crônica BCR-ABL Positiva/genética , Análise de Sobrevida , Resultado do TratamentoRESUMO
The investigation deals with a simplified modification or molecular-genetic detection of translocation t(9;22) using a combination of reverse transcription and polymerase chain reactions (RT-PCR). Unlike the available protocols, analysis is carried out using one enzyme--TET-Z polymerase--(instead of two) which has both revertase and DNA-polymerase activities. The present modification is highly sensitive, less time-consuming and cheaper. The method has proved useful for both diagnosing t(9;22) translocation and diagnosing and monitoring minimal residual disease remaining after marrow transplantation.