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获得DMR的慢性粒细胞白血病患者停用二代TKI的系统回顾和meta分析

狄 琼楠, 秦 玲, 邓 会阳, 赵 颖欣

摘要

目的应用Meta分析方法评估具有稳定深层分子反应(DMR)的慢性粒细胞白血病(CML)患者停用二代酪氨酸激酶抑制剂(2G-TKI)的安全性,评估可能影响复发的因素,为临床停药提供依据。方法通过搜索PubMed,Cochrane Library,Embase以及知网、维普、万方电子数据库,检索出2019年1月之前获得稳定DMR的CML患者停用2G-TKI的相关研究,根据纳入标准和排除标准进行文献筛选,提取相关资料,使用纽卡斯尔-渥太华量表评价研究质量和偏倚风险,使用STATA 12.0统计学软件分析CML患者停药后的12个月和24个月无治疗缓解率的平均效应大小和95%置信区间,通过亚组分析和敏感性分析评估研究间的异质性,必要时进一步计算失安全系数。结果:纳入5项单臂的前瞻性队列研究,共包括517名患者。随访12个月的总体加权平均TFR率达到57%(95%CI 51-64%;I2=56.4%)。在24个月的随访中,加权平均TFR率为53%(95%CI 47-60%;I2=47.1%)。在分子复发后重新开始TKI治疗的患者中,有96.5%的患者迅速达到了主要分子反应(MMR)。在2G-TKI治疗之前使用过干扰素(IFN)治疗对停药之后TFR的维持是有利的。结论在具有稳定DMR的CML患者中停用2G-TKI是可行的。既往使用过IFN治疗可能对CML患者停药后TFR的维持更有利。

关键词

慢性粒细胞白血病;二代酪氨酸激酶抑制剂;深层分子学反应;停药;meta分析

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参考

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