NK细胞绝对值对初诊慢性粒细胞白血病慢性期患者TKI治疗反应的预测价值
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国家自然科学基金(81870119)


Predictive value of absolute NK cells counts in response to TKI in newly diagnosed chronic phase chronic myeloid leukemia patients
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    摘要:

    目的:探讨初诊慢性粒细胞白血病(chronic myeloid leukemia,CML)患者初诊时自然杀伤细胞绝对值(absolute natural killer cell counts,ANKC),以及接受酪氨酸激酶抑制剂(tyrosine kinase inhibitor,TKI)治疗后ANKC的变化对治疗反应(治疗后3、12个月)的预测价值。方法:回顾性纳入80例初诊CML慢性期(CML-CP)患者,均接受一代或二代TKI(伊马替尼或尼洛替尼、达沙替尼)治疗,依据治疗反应分为最佳反应和警告/治疗失败两组,进行ANKC及相关临床资料对预后影响的分析。利用受试者工作特性(receiver operating characteristic,ROC)曲线优化临床指标的cut-off值。结果:初诊时ANKC≥0.14×109个/L的患者3个月和12个月治疗反应明显优于ANKC低者(P < 0.05)。TKI治疗3个月后达最佳反应的患者,3个月时 ANKC较初诊时明显降低(P < 0.001),而疗效为警告/治疗失败的患者ANKC则明显增高(P=0.017)。动态分析13例患者初诊、治疗3个月、治疗12个月时ANKC变化与疗效相关性,发现达最佳反应的患者,ANKC 在治疗3个月时较初诊时明显降低(P=0.025),治疗12个月则较初诊时明显增高(P=0.015)。结论:CML-CP患者的ANKC为TKI治疗反应的有效预测预后指标,初诊时ANKC≥0.14×109个/L可预测最佳治疗反应。

    Abstract:

    Objective: To investigate the dynamic change of absolute natural killer cell counts(ANKC) and its prognostic value for the treatment response in the newly diagnosed patients with chronic myeloid leukemia(CML) before and after 3 months and 12 months of tyrosine kinase inhibitors(TKI) treatment. Methods:All 80 patients with chronic-phase CML(CML-CP) diagnosed from 2014 to 2019 were treated with first-generation TKI(imatinib) or second-generation TKI(nilotinib, dasatinib). According to the treatment response,they were divided into two groups:the optimal response group and the warning/treatment failure group,aiming to analyze the influence of ANKC and related clinical data on prognosis. The receiver operating characteristic(ROC)curve was used to optimize the cut-off values of clinical indicator. Results:After 3 months and 12 months of treatment,the efficacy of patients with ANKC≥0.14×109 /L at the first diagnosis was better than those with lower ANKC(P < 0.05). Following 3 months of TKI treatment,ANKC in patients with optimal response was significantly lower than that at initial diagnosis(P < 0.001),whereas ANKC in patients without optimal response was significantly higher(P=0.017). Dynamic analysis was performed on the correlation between the changes in ANKC and the efficacy in 13 patients receiving dasatinib,and we found that in the patients with optimal response,ANKC after 3 months of treatment was significantly lower than that at the initial diagnosis(P=0.025),whereas ANKC after 12 months of treatment was significantly higher than that at the initial diagnosis(P=0.015). Multivariate analysis showed that ANKC,white blood cells count and second-generation TKI were independent factors for treatment response(P < 0.05). Conclusion:ANKC in CML-CP patients is an effective prognostic factor for TKI treatment response,meanwhile patients with ANKC≥0.14×109/L at diagnosis can achieve an optimal response.

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杨丽葭,刘文洁,孙 倩,洪 鸣,钱思轩. NK细胞绝对值对初诊慢性粒细胞白血病慢性期患者TKI治疗反应的预测价值[J].南京医科大学学报(自然科学版),2020,(7):991-995

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  • 收稿日期:2020-02-12
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  • 在线发布日期: 2020-08-05
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