CAJ | 학술논문

目的总结强化预处理异基因造血干细胞移植(allo-HSCT)联合伊马替尼治疗费城染色体阳性(Ph+)急性淋巴细胞白血病(ALL)的经验.方法接受同胞allo-HSCT的Ph+ALL患者8例,移植前均达完全缓解(CR),其中5例在移植前后使用伊马替尼,3例未使用.8例中,7例采用以白消安+环磷酰胺(BuCy2)为基础的增强预处理方案,1例采用全身放疗(TBI)+Cy的增强预处理方案.患者输注单个核细胞的中位数为6.02×108/kg,输注的CD34+细胞的中位数为3.14×106/kg.术后采用环孢素A(CsA)及甲氨蝶呤(MTX)预防移植物抗宿主病(GVHD).结果 allo-HSCT后所有患者均达到白细胞植入和血小板植入,白细胞植入时间中位数为15.5 d,血小板植入时间中位数为19d;allo-HSCT后30 d,8例患者经检测均为完全供者型.患者对预处理方案的耐受性良好,未发生严重预处理相关并发症.8例患者中,4例患者发生急性GVHD,其中Ⅰ度2例,Ⅱ度1例,Ⅳ度1例.7例存活100 d以上的患者中,3例发生慢性GVHD.随访结束时共6例患者存活,其中3例无白血病存活,3例复发.死亡2例,1例死于原发病复发,1例死于急性GVHD.结论强化预处理allo-HSCT联合伊马替尼是治疗Ph+ALL的有效方法,但在应用过程中应注意伊马替尼的抗慢性GVHD作用.
목적 총결강화예처리이기인조혈간세포이식(allo-HSCT)연합이마체니치료비성염색체양성(Ph+)급성림파세포백혈병(ALL)적경험.방법 접수동포allo-HSCT적Ph+ALL환자8례,이식전균체완전완해(CR),기중5례재이식전후사용이마체니,3례미사용.8례중,7례채용이백소안+배린선알(BuCy2)위기출적증강예처리방안,1례채용전신방료(TBI)+Cy적증강예처리방안.환자수주단개핵세포적중위수위6.02×108/kg,수주적CD34+세포적중위수위3.14×106/kg.술후채용배포소A(CsA)급갑안접령(MTX)예방이식물항숙주병(GVHD).결과 allo-HSCT후소유환자균체도백세포식입화혈소판식입,백세포식입시간중위수위15.5 d,혈소판식입시간중위수위19d;allo-HSCT후30 d,8례환자경검측균위완전공자형.환자대예처리방안적내수성량호,미발생엄중예처리상관병발증.8례환자중,4례환자발생급성GVHD,기중Ⅰ도2례,Ⅱ도1례,Ⅳ도1례.7례존활100 d이상적환자중,3례발생만성GVHD.수방결속시공6례환자존활,기중3례무백혈병존활,3례복발.사망2례,1례사우원발병복발,1례사우급성GVHD.결론 강화예처리allo-HSCT연합이마체니시치료Ph+ALL적유효방법,단재응용과정중응주의이마체니적항만성GVHD작용.
Objective To evaluate the outcome of combination of intensive preconditioning regimen allo-HSCT with imatinib for treatment of Ph chromosome positive acute lymphocyte leukemia (ALL). Methods Between 2009 and 2010, 8 patients diagnosed as Ph+ ALL received allo-HSCT from HLA identical sibling during complete remission. Imatinib was added into the therapies of 5 patients.Seven patients received the intensive preconditioning regimen based on BuCy2, one patient received the regimen of TBI-Cy. A median of 6. 02 × 108/kg mononuclear cells and 3. 14 × 106/kg CD34+ cells were transfused. GVHD prophylaxis included cyclosporine A and methotrexate. Results All patients were well tolerant to the regimen without serious regimen-related toxicity. The median time of ANC≥0. 5 × 109/L was 15. 5 days, and that of PLT≥20 × 109/L was 19 days. Thirty days after allo-HSCT, all patients got donor engraftment successfully. Among 8 cases, 4 cases presented acute GVHD, 2 developed degree Ⅰ , one developed degree Ⅱ , and one developed degree Ⅳ. Seven patients were alive 100 days after allo-HSCT, 3 of whom presented chronic GVHD. At the end of following-up period, 6 patients were alive, among them, 3 patients were alive without relapse; 3 patients relapsed; Two patients died, one from acute GVHD, and one from leukemia relapse. Conclusion Combined intensive preconditioning regimen allo-HSCT with Imatinib was an effective treatment for Ph+ ALL, but the effect of anti-chronic GVHD of imatinib should arouse certain attention.