CAJ | 학술논문

目的探讨伊马替尼联合化疗和异基因造血干细胞移植(allo-HSCT)治疗Ph~+急性淋巴细胞白血病(Ph~+-ALL)的疗效及转归.方法总结我院2006年1月至2009年3月的初诊Ph~+-ALL患者30例.诱导化疗均采用CDOLP方案,其中16例化疗不敏感者联合伊马替尼治疗.11例进行allo-HSCT,19例采用大剂量的阿糖胞苷、甲氨蝶呤、环磷酰胺巩同治疗.维持化疗采用VP方案联合伊马替尼.结果 30例患者中17例WBC>30×10~9/L;29例细胞免疫学标记为B系表达;1例为T系表达;24例伴附加染色体异常.诱导化疗总完全缓解(CR)率96.7%,中位CR时间9(2～20)个月.1年和3年总体生存(OS)率分别为(64.7±9.8)%和(30.0±12.4)%;1年和3年无事件生存(EFS)率分别为(28.8±9.5)%和(19.2±10.1)%.30例中13例bcr-abl融合基因持续转阴,持续ber-abl阴性者较持续阳性及复发者OS率高(70.7%对61.3%,P=0.267)、EFS率高(61.7%对17.3%,P=0.01).移植与化疗患者中位生存时间分别为18(5～36)个月和14(4～22)个月;移植组比化疗组OS率高(71.6%对58.8%,P=0.189)、EFS率高(36.4%对21.8%,P=0.045).高白细胞组患者和非高白细胞组患者中位生存时间分别为10(4～18)个月和29(5～36)个月.高白细胞组比非高白细胞组OS率低(46.9%对83.1%,P=0.003)、EFS率低(15.5%对50.8%,P=0.009).结论伊马替尼能够显著提高Ph~+-ALL患者的CR率和ber-abl融合基因的转阴率,延长非移植患者的缓解期.伊马替尼联合allo-HSCT有望提高Ph~+ -ALL患者的治愈率.
목적 탐토이마체니연합화료화이기인조혈간세포이식(allo-HSCT)치료Ph~+급성림파세포백혈병(Ph~+-ALL)적료효급전귀.방법 총결아원2006년1월지2009년3월적초진Ph~+-ALL환자30례.유도화료균채용CDOLP방안,기중16례화료불민감자연합이마체니치료.11례진행allo-HSCT,19례채용대제량적아당포감、갑안접령、배린선알공동치료.유지화료채용VP방안연합이마체니.결과 30례환자중17례WBC>30×10~9/L;29례세포면역학표기위B계표체;1례위T계표체;24례반부가염색체이상.유도화료총완전완해(CR)솔96.7%,중위CR시간9(2～20)개월.1년화3년총체생존(OS)솔분별위(64.7±9.8)%화(30.0±12.4)%;1년화3년무사건생존(EFS)솔분별위(28.8±9.5)%화(19.2±10.1)%.30례중13례bcr-abl융합기인지속전음,지속ber-abl음성자교지속양성급복발자OS솔고(70.7%대61.3%,P=0.267)、EFS솔고(61.7%대17.3%,P=0.01).이식여화료환자중위생존시간분별위18(5～36)개월화14(4～22)개월;이식조비화료조OS솔고(71.6%대58.8%,P=0.189)、EFS솔고(36.4%대21.8%,P=0.045).고백세포조환자화비고백세포조환자중위생존시간분별위10(4～18)개월화29(5～36)개월.고백세포조비비고백세포조OS솔저(46.9%대83.1%,P=0.003)、EFS솔저(15.5%대50.8%,P=0.009).결론 이마체니능구현저제고Ph~+-ALL환자적CR솔화ber-abl융합기인적전음솔,연장비이식환자적완해기.이마체니연합allo-HSCT유망제고Ph~+ -ALL환자적치유솔.
Objective To explore the efficacy and therapeutic outcome of imatinib combined with themotherapy or allogeneic hematopoietic stem cell transplantation(allo-HSCT)for Philadelphia chromosome positive acute lymphoblastic leukemia(ALL).Methods Thirty patients from Jan 2006 to Mar 2009 were enrolled in this study.All patients received CDOLP induction chemotherapy regimen.Sixteen patients insensitire to chemotherapy were given imatinib simultaneously.Eleven of 30 patients underwent HSCT.The other 19 cases received consolidation therapy including HD-Ara-C.HD-MTX and HD-CTX.Maintenance therapy regimens were VP combined with imatinib.Results The white blood cell(WBC)count in 17 patients was higher than 30×10~9/L.of 30 patients,29 were B cell phenotype and 1 T cell phenotype,24 had additional chromosomal abnormalities.The overall complete remission(CR)rate was 96.7%.The median CR duration was 9(2-20)months.The 1-year and 3-year overall survival(OS)rates were(64.7±9.8)%and(30.0± 12.4)%,and the event free survival(EFS)rates were(28.8±9.5)%and(19.2±10.1)%.respectivelv.The ber-abl transcripts in 13 of 30 patients were continuous negative.The OS rate in patients with negative ber-abl transcripts was higher than that with positive bcr-abl(70.7%vs61.3%)(P=0.189).The EFS rate of patients with continuous negative bcr-abl transcripts was significantly higher than that of patients with continuous positive bcr-abl transcripts(P=0.01).The median overall survival duration of higher WBC count group and normal WBC count group were 10(4-18)and 29(5-36)months,respectively.The patients of higher WBC count had lower OS and EFS rates than that of normal WBC count(46.9%and 15.5% vs 83.5%and 50.8%,respectively)(P=0.003 and 0.009,respectively).Conclusion Imatinib can significantly improve molecular CR rate and CR duration for Ph~+ ALL patients.Imatinib combined with allo HSCT is expectable to improve the curative ratio of these patients.