CAJ | 학술논문

目的探讨采用伊马替尼(IM)联合化疗后第1次完全缓解期(CR1)行异基因造血干细胞移植(allo-SCT)及IM维持治疗成人Ph阳性急性淋巴细胞白血病(Ph+-ALL)的临床疗效及相关预后因素.方法 2006年3月至2010年12月在我院淋巴肿瘤中心CR1期完成allo-SCT治疗的16例成人Ph+-ALL患者纳入研究.所有患者均以IM联合标准VDCP±L(长春新碱+柔红霉素+环磷酰胺+泼尼松±左旋门冬酰胺酶)方案诱导治疗,缓解后则联合改良HyperCVAD/MA方案强化巩固治疗,并于CR1期行allo-SCT;部分患者移植后给予IM维持治疗.随访至2011年3月31日,分析患者临床基本特征、总生存(OS)率、无病生存(DFS)率、累积复发(RI)率及非复发死亡(NRM)率,并探讨与生存相关的预后因素.结果 16例患者采用IM联合化疗在移植前均维持血液学缓解,其中10例达分子生物学缓解.移植后所有患者均成功植入.中位随访27.1(7.4 ～65.8)个月,14例患者存活,其中2例患者移植后复发经IM挽救均存活,2例非复发死亡.3年预期OS及DFS率分别为(85.9±9.3)％和(83.9±10.5)％,3年RI率及NRM率分别为(16.1±10.5)％和(14.1±9.3)％.生存分析未显示影响移植疗效的预后因素.结论 IM联合化疗及Hyper-CVAD/MA强化治疗可显著提高Ph+-ALL患者的缓解率及缓解质量,使患者在CR1期行allo-SCT的可行性增高.allo-SCT前、后联合IM能减少复发,提高长期OS及DFS率,是治疗成人Ph+-ALL的有效手段.
목적 탐토채용이마체니(IM)연합화료후제1차완전완해기(CR1)행이기인조혈간세포이식(allo-SCT)급IM유지치료성인Ph양성급성림파세포백혈병(Ph+-ALL)적림상료효급상관예후인소.방법 2006년3월지2010년12월재아원림파종류중심CR1기완성allo-SCT치료적16례성인Ph+-ALL환자납입연구.소유환자균이IM연합표준VDCP±L(장춘신감+유홍매소+배린선알+발니송±좌선문동선알매)방안유도치료,완해후칙연합개량HyperCVAD/MA방안강화공고치료,병우CR1기행allo-SCT;부분환자이식후급여IM유지치료.수방지2011년3월31일,분석환자림상기본특정、총생존(OS)솔、무병생존(DFS)솔、루적복발(RI)솔급비복발사망(NRM)솔,병탐토여생존상관적예후인소.결과 16례환자채용IM연합화료재이식전균유지혈액학완해,기중10례체분자생물학완해.이식후소유환자균성공식입.중위수방27.1(7.4 ～65.8)개월,14례환자존활,기중2례환자이식후복발경IM만구균존활,2례비복발사망.3년예기OS급DFS솔분별위(85.9±9.3)％화(83.9±10.5)％,3년RI솔급NRM솔분별위(16.1±10.5)％화(14.1±9.3)％.생존분석미현시영향이식료효적예후인소.결론 IM연합화료급Hyper-CVAD/MA강화치료가현저제고Ph+-ALL환자적완해솔급완해질량,사환자재CR1기행allo-SCT적가행성증고.allo-SCT전、후연합IM능감소복발,제고장기OS급DFS솔,시치료성인Ph+-ALL적유효수단.
Objective To explore the efficacy of imatinib(IM)-based chemotherapy followed by allogeneic hematopoietic stem cell transplantation(allo-SCT)in first complete remission(CR1)for adult Ph +acute lymphoblastic leukemia[Ph+-ALL].Methods From March 2006 to December 2010,16 adult Ph +ALL were enrolled in the study.All patients received IM combined with standard VDCP ± L as induction therapy then intensive consolidation with modified Hyper-CVAD/MA regimen plus IM,and followed by allo-SCT in CR1.Some of them received IM maintenance therapy after allo-SCT.With the follow up to March 31,2011,the clinical parameters,overall survival(OS),disease free survival(DFS),relapse incidence(RI),non-relapse mortality(NRM)and prognostic factors were analyzed.Results All 16 patients achieved morphological complete remission(CR),and 10 of them achieved molecular CR.After transplantation,all patients obtained successful engraftments.With a median follow-up of 27.1(7.4-65.8)months,14 patients were alive,2 died from NRM,and 2 relapsed.The estimated OS and DFS at 3 year were(85.9 ± 9.3)％and(83.9 ± 10.5)％,and cumulative RI and NRM at 3 year were(16.1 ± 10.5)％ and(14.1 ±9.3)％,respectively.None prognostic factor was found on analysis.Conclusion IM combined with intensive chemotherapy significantly increased the CR rate and improved the quality of CR,which prepared the feasibility of allo-SCT in CR1.IM therapy pre-and post-allo-SCT would be a promising strategy for adult Ph+-ALL to decrease relapse and facilitates favorable OS and DFS.