Ali Veysel KARA, SALİH AKSU

İmatinib tedavisi alan kronik myeloid lösemi hastalarında tedavi etkinliğinin ve prognozun değerlendirilmesi

Amaç: Kronik myeloid lösemi (KML), immatür hematopoietik kök hücrelerinin neoplastik transformasyonu sonucuoluşan klonalmyeloproliferatif bir hastalıktır. Spesifik BCR-ABL protein tirozin kinaz inhibitörü (TKİ) imatinib mesilatklinik uygulamaya girdikten sonra KML tedavisinde yeni bir dönem başlamıştır. Bugün KML tedavisinde imatinibmesilat ilk tercih edilen tedavi seçeneğidir ancak imatinib mesilat tedavisine yanıtsızlık ve intoleransgelişebilmektedir. Bu çalışmamızda TKİ tedavisi verilen KML hastalarında tedavi etkinliğinin ve prognozundeğerlendirilmesi amaçlandı.Yöntemler: Çalışmamızda Hacettepe Üniversitesi Tıp Fakültesi Erişkin Hastanesi Hematoloji Ünitesinde Kasım 1995ile Aralık 2009 tarihleri arasında takip edilen 16 yaşından büyük 54 KML hastası çalışmaya dahil edildi. Verilereretrospektif olarak hasta dosya kayıtlarından ulaşıldı. Hastaların TKİ başlandığı sıradaki hastalık evrelemesi DünyaSağlık Örgütü (WHO) kriterlerine göre yapıldı. Tanı anındaki risk profiliSokal risk skorlamasına göre değerlendirildi.Yanıt oranları (hematolojik ve sitogenetik), relaps oranı (hematolojik, sitogenetik ve moleküler relapstan herhangibirinin varlığı), relaps bağımsız sağkalım ve genel sağkalım değerlendirildi. Hastaların sağkalım eğrileri Kaplan Meieryöntemi ile değerlendirildi.Bulgular: Çalışmamızda hastaların %94,4’ ünde tam hematolojik yanıt (THY) ve %75,9’ unda tam sitogenetik yanıt(TSY) elde edildi. Çalışmamızda relaps oranı %31,5 olarak bulundu. Hastaların %40’ında imatinib tedavisisonlandırıldı. Bu hastaların %40’ında primerimatinib direnci, %46,6’ sında sekonder imatinib direnci ve %13,4’ ündeyan etki nedeniyle tedavi sonlandırıldı. 18 aylık ve 5 yıllık relaps bağımsız sağkalım sırasıyla %86,7 ve %56,2 idi.Genel sağkalım açısından değerlendirildiğinde, 3 ve 5 yıllık genel sağkalım oranı %93,7 olarak hesaplandı.Sonuç: imatinib tedavisinin tolere edilebilir etkin bir tedavi yöntemi olduğu ancak günümüzde daha yeni TKİ’ lerinklinik uygulamaya girmesiyle birlikte, TKİ’ leri veya kombinasyonlarını etkinlik ve tolerabilite açısından kıyaslayacakçalışmaların yapılmasıyla, KML tedavisinde en uygun tedavi seçeneğinin belirlenebileceği düşünüldü.

Evaluation of efficacy of treatment and prognosis in chronic myeloid leukemia patients treated with imatinib

Objective: Chronic myeloid leukemia (CML), is a clonal myeloproliferative disease due to neoplastic transformation of immature hematopoietic stem cells. The introduction of imatinib mesylate, specific BCR-ABL tyrosine kinase inhibitor (TKİ), opened a new era in treatment of CML. Currently, imatinib is considered as the first line treatment regime for CML however nonresponse or intolerance to imatinib therapy may develop. The aim of our study is to evaluate the prognosis and the efficacy of treatment in CML patients treated with TKİ. Methods: In the study; 16 years old and older 54 patients with CML who had been followed-up at Adult Hematology Department in the university hospital between November 1995 and December 2009, were analyzed retrospectively. The disease phases of patients when the TKİ was started were defined according to criteria proposed by World Health Organization (WHO). Risk profiles of patients at the time of diagnosis were determined by Sokal risk scoring system. Response rates (hematologic and cytogenetic), relapse rate (hematologic, cytogenetic or molecular relapse), relapse free survival and overall survival were evaluated. The survival curves were evaluated by Kaplan Meier method. Results: In our study, complete hematologic response(CHR) and complete cytogenetic response (CCR) rates were 94.4% and 75.9%, respectively. Relapse rate was 31.5%. Imatinib therapy was discontinued 40% of patients. Causes for imatinib discontinuation were primary imatinib resistance (40%), secondary imatinib resistance (46.6%) and side effects (13.4%). Estimated rate of relapse free survival was86.7% at 18 months and 56.2% at 5 years. Estimated three-year and five-year overall survival rates were 93.7%. Conclusion: It was concluded that imatinib mesylate is an effective and tolerable treatment choice but further studies that compares TKİ’ s or combinations in terms of efficacy and tolerabilitiy are required to decide the most appropriate treatment choice in CML treatment.

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