中华器官移植杂志
中華器官移植雜誌
중화기관이식잡지
CHINESE JOURNAL OF ORGAN TRANSPLANTATION
2011年
3期
132-136
,共5页
刘欣%魏嘉璘%何祎%王玫%杨栋林%黄勇%姜尔烈%阎嶂松%马巧玲%邱录贵%冯四洲%韩明哲
劉訢%魏嘉璘%何祎%王玫%楊棟林%黃勇%薑爾烈%閻嶂鬆%馬巧玲%邱錄貴%馮四洲%韓明哲
류흔%위가린%하의%왕매%양동림%황용%강이렬%염장송%마교령%구록귀%풍사주%한명철
白血病,淋巴细胞,急性%费城染色体%造血干细胞移植%伊马替尼
白血病,淋巴細胞,急性%費城染色體%造血榦細胞移植%伊馬替尼
백혈병,림파세포,급성%비성염색체%조혈간세포이식%이마체니
Leukemia,lymphocytic,acute%Philadelphia chromosome%Hematopoietic stem cell transplantation%Imatinib
目的 观察造血干细胞移植(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)患者的疗效,分析影响预后的因素.方法 Ph+ALL患者32例,全部患者移植前均达血液学完全缓解,其中第1次缓解(CR1)期27例,CR2期5例.19例患者移植前达到分子生物学缓解(MR).32例中,自体移植4例,异基因移植28例.采用全身照射(TBI)+环磷酰胺(Cy)+氟达拉滨(Flu)+阿糖胞苷(Ara-C)的预处理方案.患者输注单个核细胞的中位数为5.6×108/kg,输注CD34+细胞中位数为2.94×106/kg.31例患者于HSCT前应用伊马替尼,口服,400～600 mg/d;16例患者于HSCT后应用伊马替尼,包括预防性治疗7例,剂量为300～400mg/d,治疗9例,剂量为400～600 mg/d.结果 32例患者移植后均获得造血重建.全部患者预期3年总体存活率为(62.1±8.6)%,无白血病存活率为(59.2±8.7)%,复发率为(17.7±7.2)%,移植相关死亡率为(26.2±8.0)%.4例自体移植患者均存活,其中3例已持续缓解14、18和67个月.对异基因移植进行单因素分析显示,行HLA匹配亲缘HSCT者的总体存活率为76.5%,高于行无关供者或HLA半相合亲缘HSCT者(27.3%,P＜0.05),前者无白血病存活率也高于后者(分别为70.6%和27.3%,P＜0.05).移植前获得MR者的复发率为5.6%,低于未缓解者(40.0%,P＜0.05),移植前处于CR1期者的复发率为12.5%,低于CR2期者(50.0%,P＜0.05).结论 伊马替尼联合HSCT可用于治疗Ph+ALL患者,移植前获得MR或于CR1期进行移植者的预后更佳.
目的 觀察造血榦細胞移植(HSCT)聯閤伊馬替尼治療費城染色體暘性(Ph+)急性淋巴細胞白血病(ALL)患者的療效,分析影響預後的因素.方法 Ph+ALL患者32例,全部患者移植前均達血液學完全緩解,其中第1次緩解(CR1)期27例,CR2期5例.19例患者移植前達到分子生物學緩解(MR).32例中,自體移植4例,異基因移植28例.採用全身照射(TBI)+環燐酰胺(Cy)+氟達拉濱(Flu)+阿糖胞苷(Ara-C)的預處理方案.患者輸註單箇覈細胞的中位數為5.6×108/kg,輸註CD34+細胞中位數為2.94×106/kg.31例患者于HSCT前應用伊馬替尼,口服,400～600 mg/d;16例患者于HSCT後應用伊馬替尼,包括預防性治療7例,劑量為300～400mg/d,治療9例,劑量為400～600 mg/d.結果 32例患者移植後均穫得造血重建.全部患者預期3年總體存活率為(62.1±8.6)%,無白血病存活率為(59.2±8.7)%,複髮率為(17.7±7.2)%,移植相關死亡率為(26.2±8.0)%.4例自體移植患者均存活,其中3例已持續緩解14、18和67箇月.對異基因移植進行單因素分析顯示,行HLA匹配親緣HSCT者的總體存活率為76.5%,高于行無關供者或HLA半相閤親緣HSCT者(27.3%,P＜0.05),前者無白血病存活率也高于後者(分彆為70.6%和27.3%,P＜0.05).移植前穫得MR者的複髮率為5.6%,低于未緩解者(40.0%,P＜0.05),移植前處于CR1期者的複髮率為12.5%,低于CR2期者(50.0%,P＜0.05).結論 伊馬替尼聯閤HSCT可用于治療Ph+ALL患者,移植前穫得MR或于CR1期進行移植者的預後更佳.
목적 관찰조혈간세포이식(HSCT)연합이마체니치료비성염색체양성(Ph+)급성림파세포백혈병(ALL)환자적료효,분석영향예후적인소.방법 Ph+ALL환자32례,전부환자이식전균체혈액학완전완해,기중제1차완해(CR1)기27례,CR2기5례.19례환자이식전체도분자생물학완해(MR).32례중,자체이식4례,이기인이식28례.채용전신조사(TBI)+배린선알(Cy)+불체랍빈(Flu)+아당포감(Ara-C)적예처리방안.환자수주단개핵세포적중위수위5.6×108/kg,수주CD34+세포중위수위2.94×106/kg.31례환자우HSCT전응용이마체니,구복,400～600 mg/d;16례환자우HSCT후응용이마체니,포괄예방성치료7례,제량위300～400mg/d,치료9례,제량위400～600 mg/d.결과 32례환자이식후균획득조혈중건.전부환자예기3년총체존활솔위(62.1±8.6)%,무백혈병존활솔위(59.2±8.7)%,복발솔위(17.7±7.2)%,이식상관사망솔위(26.2±8.0)%.4례자체이식환자균존활,기중3례이지속완해14、18화67개월.대이기인이식진행단인소분석현시,행HLA필배친연HSCT자적총체존활솔위76.5%,고우행무관공자혹HLA반상합친연HSCT자(27.3%,P＜0.05),전자무백혈병존활솔야고우후자(분별위70.6%화27.3%,P＜0.05).이식전획득MR자적복발솔위5.6%,저우미완해자(40.0%,P＜0.05),이식전처우CR1기자적복발솔위12.5%,저우CR2기자(50.0%,P＜0.05).결론 이마체니연합HSCT가용우치료Ph+ALL환자,이식전획득MR혹우CR1기진행이식자적예후경가.
Objective To analyze the outcomes and the prognostic factors of hematopoietic stem cell transplantation (HSCT) in combination with imatinib for Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ ALL). Methods All 32 patients with Ph+ ALL achieved hematologic complete remission (CR) at time of transplantation, including 27 cases in the first CR (CR1) and 5 in CR2. Nineteen patients achieved molecular remission (MR). Among 32 patients, 4 received autologous HSCT (AHSCT), and 28 allogeneic HSCT (allo-HSCT). The conditioning regimens comprised of total body irradiation (TBI), cyclophosphamide, fludarabine and cytarabine. The median number of transfused mononuclear cells was 5. 6 × 108/kg, and that of CD34+ cells was 2. 94 × 106 /kg. Thirty-one patients were administrated imatinib orally before transplantion, at a dose of 400～600 mg/day, and 16 patients after transplantation, including 7 for prevention at a dose of 300～400 mg/day and 9 for salvage treatment at a dose of 400 ～ 600 mg/day. Results Hematopoietic reconstitution was achieved in all 32 patients. Three-year estimate of overall survival (OS) was (62. 1±8. 6)%, leukemia-free survival (LFS) (59. 2 ± 8. 7)%, relapse rate (RR) (17. 7 ± 7. 2)% and transplant-related mortality (26. 2 ± 8. 0) %. All 4 undergoing AHSCT were alive, and 3 out of them were in continuous CR with durations of 14, 18 and 67 months respectively. The univariate analysis for prognosis in allo-HSCT showed that the OS of HLA-matched sibling donors group was 76. 5 %,higher than that of unrelated or haploidentical donors group (27. 3 %, P＜0. 05), and so was LFS (70. 6 % vs 27. 3 %, P＜0. 05). RR in patients achieving MR at time of transplantation was 5. 6 %,lower than that in those not achieving MR (40. 0 %, P＜0. 05). RR in patients in CR1 at time of transplantation was 12. 5 %, lower than that in those in CR2 (50 %, P ＜0. 05). Conclusion Imatinib improved the outcomes of HSCT for Ph+ ALL, especially to patients achieving MR at time of transplantation and transplantation in early stage (CR1).
