单中心74例慢性髓系白血病一线伊马替尼治疗中IMTF预测模型的价值

目的:探讨伊马替尼治疗失败（imatinib-therapy failure,IMTF)预测模型在不同预后分层患者的完全细胞遗传学反应(complete cytogenetic response,CCyR）、主要分子反应(major molecular response，MMR)、分子反应4.0(molecular response 4.0，MR4.0)、分子反应4.5(molecular response 4.5，MR4.5)、无治疗失败生存（failure-free survival,FFS）中的预测价值，分析早期是否获得最佳疗效对远期持续深层分子反应(deep molecular response,DMR)的意义。方法:收集我中心2018年至2021年确诊185例Ph阳性慢性髓系白血病(chronic myelogenous leukemia,CML)患者的临床资料，随访并进行预后分析。结果:185例患者中，74例患者进行规律治疗并定期监测，中位发病年龄为45.5(11~78)岁，男性占68.9%（51/74），脾大患者占64.9%（48/74）;Sokal评分下低危45例（60.8%）、中危26例（35.1%）、高危3例（4.1%），低中危组患者FFS明显优于高危组的患者；ELTS评分下低危15例（20.3%）、中危31例（41.9%）、高危28例（37.8%），不同预后分层患者的CCyR、MMR、MR4.0及MR4.5、FFS均无统计学差异；IMTF积分下极低危4例（5.4%）、低危10例（13.5%）、中危23例（31.1%）、高危26例（35.1%）、极高危11例（14.9%），在FFS方面，极高危组的患者预后差；3个月时融合基因＜10%占59.4%（41/69），3个月时早期达到最佳疗效与未达到最佳疗效的患者相比，2年及5年DMR均有显著差异，6个月及12个月是否达到最佳疗效对2年及5年DMR没有影响。结论:IMTF模型与传统的积分相比，可以更加精准地筛选出潜在极高危的患者，并更好地预测FFS，进一步区分出可能出现伊马替尼失败的这部分患者，指导TKI药物的选择，有助于远期持续DMR。

Value of IMTF prediction model in 74 patients with chronic myelogenous leukemia treated with first-line imatinib in a single center

Objective:To investigate the predictive value of imatinib-therapy failure (IMTF) prediction model in complete cytogenetic response （CCyR）,major molecular response （MMR）,molecular response 4.0 （MR4.0),molecular response 4.5 （MR4.5) and failure-free survival （FFS） of patients with different prognostic stratifications,and to analyse the significance of early optimal response on long-term sustained deep molecular response (DMR).Methods:Clinical and follow-up data were collected for analyzing the prognosis in 185 patients with Ph-positive chronic myelogenous leukemia (CML) in our centre from 2018 to 2021.Results:Among the 185 patients,74 patients received regular treatment and regular monitoring.The median age of onset was 45.5 (11~78) years old.68.9% (51/74) patients were males.64.9% (48/74) patients had splenomegaly.According to the Sokal score,there were 45 (60.8%) patients in low risk,while there were 26 (35.1%) patients in intermediate risk,and 3 (4.1%) patients in high risk.FFS of patients in low and intermediate risk group was significantly better than those in high risk group.According to the ELTS score,there were 15 (20.3%) patients in low risk,while there were 31 (41.9%) patients in intermediate risk,and 28 (37.8%) patients in high risk.CCyR,MMR,MR4.0,MR4.5,FFS were not statistically significant in patients with different prognostic stratifications.According to the IMTF score,there were 4 (5.4%) patients in very low risk,10 (13.5%) patients in low risk,23 (31.1%) patients in intermediate risk,26 (35.1%) patients in high risk,and 11 (14.9%) patients in very high risk.In FFS,the prognosis of patients in the very high risk group was poor.59.4% (41/69) patients had fusion gene <10% at 3 months.There was a significant difference in DMR at 2 and 5 years between patients who achieved an early optimal response at 3 months and those who did not.There was no difference in DMR at 2 and 5 years between patients who achieved an optimal response at 6 and 12 months and those who did not.Conclusion:Compared with the traditional score,the IMTF model can more accurately screen the potentially very high-risk patients,better predict FFS and further distinguish the patients who may have imatinib failure,guide the selection of TKI drugs and contribute to the long-term sustained DMR.