2013--服药6个月时融合基因降到10%，预后好_慢粒血液病吧_百度贴吧
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2013--服药6个月时融合基因降到10%，预后好
摘要：以下研究和其他研究显示，服药3-6个月后融合基因低于10%（按照国际标准IS），长期预后好。3个月时融合基因低于10%的患者，整体生存率在90%以上，如果高于10%，则整体生存率降为80%多，6个月时融合基因若高于10%，则整体生存率为70%多。因此尽早缓解能产生良好的预后。确诊时、第一年每隔3个月一定要做PCR融合基因。 来源：2013ASH会议摘要 Dear Group, According to this study and other studies, a PCR of less than 10% on the International Scale at 3-6 months is desirable for good long-term outcome. Those patients who had PCR values less than 10% at the 3 month mark had 90% and more overall survival and this dropping to the 80%+ mark if the PCR was more than 10% at the 3 month mark and 70%+ mark if the PCR was more than 10% at the 6 month mark. So early response bodes well for good long-term outcomes. So make sure you do your PCR at diagnosis and at 3-monthly intervals for the first year of diagnosis. Best Wishes,Anjana Coverage/Hematology 2013/CML/Capsules/254.aspx Reduction of BCR-ABL Level & 10% by 6 Months of Treatment Improves Long-term Clinical Outcome for CML Patients With Suboptimal Response at 3 MonthsSource: 2013 American Society of Hematology Annual Meeting* Conference ProgramMDS and Acute Leukemias•Capsule Summaries (10)•Expert Analysis (CME) (Coming soon)•Downloadable slideset (Coming soon)CLL + Other B-Cell Malignancies•Capsule Summaries (10)•Expert Analysis (CME) (Coming soon)•Downloadable slideset (Coming soon)Chronic Myeloid Leukemia•Capsule Summaries (10)•Expert Analysis (CME) (Coming soon)•Downloadable slideset (Coming soon)Myeloma•Capsule Summaries (10)•Expert Analysis (CME) (Coming soon)•Downloadable slideset (Coming soon)
Capsule SummaryDate posted: 12/11/2013Prospective, nonrandomized, observational study[1]Summary of Key ConclusionsReduction of BCR-ABL level to & 10% by International Scale (IS) between 3 and 6 months leads to improved outcome in patients with chronic-phase chronic myeloid leukemia (CML) and suboptimal molecular response to imatinib at 3 monthsBCR-ABL level & 10% at 3 months confirmed as poor-risk category for long-term clinical outcomes in patients with chronic-phase CMLBCR-ABL level assessment at 6 months provides important clinical information that may guide treatment decisionsBackgroundPrognostic value of 3-month molecular response to tyrosine kinase inhibitor well established in CMLRecent updates to management guidelines now include molecular assessment at early time points to evaluate response to treatmentNational Comprehensive Cancer Network practice guidelines classify BCR-ABL & 10% at 3 months as treatment failureEuropean LeukemiaNet (ELN) recommendations classifyBCR-ABL & 10% at 6 months as treatment failureMixed results in literature on the prognostic value of 6-month assessment[2-4]Current study examined prognostic importance of assessing molecular responses at both 3 and 6 months in large patient cohort by determining whether poor 3-month response always predicts poor outcome regardless of subsequent molecular response[1]Summary of Study DesignProspective observational study of clinical outcomes of chronic-phase CML patients receiving imatinib in clinical trialsPatients grouped based on ELN molecular response categories at 3 and 6 months3 months: BCR-ABL ≤ 10%IS = BCR-ABL & 10%IS = warning6 months: BCR-ABL & 1%IS = BCR-ABL 1% to 10%IS= BCR-ABL& 10%IS = failureMolecular response categories assessed for prediction of clinically relevant outcomesOSPFS, progression to accelerated phase/blast crisisTreatment failure, failure-free survival (FFS), BCR-ABL &10%ISMajor molecular response (MMR)Baseline Characteristics528 chronic-phase CML patients who received frontline imatinib in clinical trials Description of Current AnalysisAnalyzed clinical outcomes at 4 years based on 3- and 6-month “optimal,” “warning,” and “failure” molecular response levelsPatients in “warning” category at 3 months received molecular reassessment at 6 months and regrouped according to 6-month response levelRate of BCR-ABL reduction from baseline levels analyzed to assess predictive value for ongoing riskIn 3-month “warning” group, compared outcome according to 3-month halving timeHalving time: number of days over which BCR-ABL halvedMain FindingsPoor molecular response at 3 months predictive of poorer clinical outcomes at 4 years compared to optimal 3-month responseBCR-ABL & 10%IS at 6 months alone not counted as failure in absence of other failure event for this FFS analysisOutcomes at4 Yrs, %Optimal Level 3-MoBCR-ABL, ≤ 10%IS(n = 406)Warning Level 3-MoBCR-ABL, & 10%IS(n = 100)PValueOSPFS9986*& .0001FFS8346& .0001MMR8942& .0001*11 of 13 progressions advanced to accelerated phase/blast crisis within first year of starting imatinib.Molecular changes between 3-6 months can affect long-term clinical outcomesMajority of patients in 3-month warning category received different classification after 6-month reassessment18 (20%) optimal BCR-ABL response36 (40%) warning35 (40%) failurePatients who failed 6-month molecular reassessment had significantly poorer 4-year clinical outcomes than other 2 groupsSignificant difference between 4-year outcomes in optimal and warning groups at 6 months seen only for MMR (P = .001)Outcomesat 4 Yrs, %Optimal Level 6-MoBCR-ABL, & 1%IS(n = 18)Warning Level 6-MoBCR-ABL, 1%IS to 10%IS(n = 36)Failure Level 6-MoBCR-ABL, & 10%IS(n = 35)PValueOSPFSFFS76810& .0001MMR88653& .0001MMRs achieved by patients who moved from 3-month warning group to 6-month optimal group indistinguishable from those of patients in 3-month optimal groupOther OutcomesAmong patients with BCR-ABL & 10% at 3 months, significantly inferior 4-year outcomes observed for those whose BCR-ABL did not reduce by at least one half within 90 daysMedian halving rate: 32 days (range: 16-90)Outcomes at 4 Yrs, %Halving Time≤ 90 Days(n = 79)Halving Time& 90 Days(n = 19)PValueOSPFSFFS567& .0001MMR535.017Halving time at 3 months may also predict survival outcome for patients who failed to have molecular responses at 6 months (n = 35)Outcomes at 2 Yrs, %Halving Time≤ 90 Days(n = 22)Halving Time& 90 Days(n = 13)PValueOS9666.03PFS9165.08References1. Branford S, Roberts N, Yeung DT, Altamura H, Parker WT, Hughes TP. Any BCR-ABL reduction below 10% at 6 months of therapy significantly improves outcome for CML patients with a poor response at 3 months. Program and abstracts of the 55th American Society of Hematology Annual Meeting and E December 7-10, 2013; New Orleans , Louisiana . Abstract 254.2. Marin D, Ibrahim AR , Lucas C, et al. Assessment of BCR-ABL1 transcript levels at 3 months in the only requirement for predicting outcome for patients wtih chronic myeloid leukemia treated with tyrosine kinase inhibitors. J Clin Oncol. -238.3. Neelakantan P, Gerrard G, Lucas C, et al. Combining BCR-ABL1 transcript levels at 3 and 6 months in chronic myeloid leukemia: implications for early intervention strategies. Blood. 9-2742.4. Nazha A, Kantarjian H, Jain P, et al. Assessment at 6 months may be warranted for patients with chronic myeloid leukemia with no major cytogenic response at 3 months. Haematologica. 6-1688.
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第一个没有丙型肝炎
第二个可能是得了梅毒
第三个没有htv
阴性表示未感染艾滋病毒
答: 需铁量增加但摄入量不足 多见于婴幼儿、青少年，妊娠和哺乳期、月经期妇女。铁吸收不良 多见于胃、十二指肠切除后，由于胃酸不足且食物迅速进入空肠，快速经过铁的主要吸...
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&&白​血​病​融​合​基​因​检​测​对​白​血​病​诊​断​、​治​疗​及​预​后​判​断​有​重​要​意​义
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