Abstract:

Objective
To assess the efficacy and adverse reactions of imatinib in the treatment of patients with chronic myeloid leukemia (CML),and to provide the basis for choosing the best treatment program. Methods 239 patients diagnosed as CML were divided into three groups,55 patients in CML chronic phase (CP)  CML  group were treated with imatinib,30 patients in the accelerated phase (AP) and blastic phase (BP)  group were treated with imatinib and 154 patients in CML  CP chemotherapy and/or interferon  group were treated with chemotherapy and/or interferon.The clinical symptoms after treatment,such as the  complete hematologic remission (CHR),the complete cytogenetic remission (CCR),the major molecular remission (MMR) and the side effects were analyzed.The plasma concentration,the chromosome and the mutation of the imatinib-resistant patients were deteced.Results 46 patients in  CP CML group  were in the early CP (the patients were treated within 1 year after  diagnosis,CP <1 year).100% of the patients in this group achieved CHR in 3 months,and 83% of the patients achieved CCR in 12 months,and 30% of the patients achieved MMR in 18 months.There were 9 patients in the late CP (the patients were treated more than 1 year after the diagnosis,CP> 1 year),the CHR rate was 88%,and the CCR rate was 30%,and the MMR rate was 22%. In AP and BL CML group,there were 12 AP CML patients,50% of the patients in this group achieved CHR,and 25% of the patients achieved CCR,and 17% of the patients achieved MMR;there were 18 BP CML patients,22% of the patients achieved CHR,and 16.7% achieved CCR,and no patient achieved MMR.In  CP CML chemotherapy and/or interferon group,the CHR rate was 47.4%,and both the CCR and the MMR rates were  0%.The CHR,CCR and MMR of the patients in CP CML  group were higher than those in CP CML  chemotherapy and/or interferon group(P<0.05). 14 patients in  imatinib groups were imatinib-resistant.The drug concentrations of 2 imatinib-resistant patients were tested to be declined.5 imatinib-resistant patients had complex karyotypes(including 2 CP patients,2 AP patients and 1 BP patients).The gene mutations were tested in 4 imatinib-resistant patients.Conclusion Compared with CP CML chemotherapy and/or interferon group,the patients in imatinib groups could achieve a higher hematologic,cytogenetic and molecular remission rate.The patients in  CP CML group treated with imatinb achieve a higher remission rate than AP and BP CML group.The remission rate of the patients in  early CP group is higher than that in late CP group.

Key words: imatinib;chronic myeloid leukemia;efficacy;adverse reaction