异基因造血干细胞移植治疗伊马替尼耐药Ph染色体阳性白血病
이기인조혈간세포이식치료이마체니내약Ph염색체양성백혈병
Allogeneic stem cell transplantation for patients with Philadelphia positive leukemia resistant to imatinib
  • 万方数据
    中华医学杂志 중화의학잡지
    National Medical Journal of China
    2008年 28期 1974-1977 ,共4页

    韩伟%刘开彦%许兰平%陈欢%刘代红%陈育红%张晓辉%张耀臣%陈瑶%王昱%王婧%陆道培%黄晓军

    한위%류개언%허란평%진환%류대홍%진육홍%장효휘%장요신%진요%왕욱%왕청%륙도배%황효군

    白血病%造血干细胞移植%费城染色体%伊马替尼耐药 白血病%造血榦細胞移植%費城染色體%伊馬替尼耐藥
    백혈병%조혈간세포이식%비성염색체%이마체니내약
    Leukemia%Hematopoietic stem cell transplantation%Philadelphia chromosome%Imatinib mesylate resistance
    目的 探讨造血干细胞移植(HSCT)作为甲磺酸伊马替尼(IM)耐药的费城染色体阳性(Ph+)白血病挽救性治疗的疗效.方法 回顾性分析2002年7月至2006年8月北京大学人民医院血液病研究所住院的14例IM耐药Ph(+)白血病患者行异基因(allo)-HSCT的效果,其中复发/难治急性淋巴细胞白血病(ALL)3例,慢性髓性白血病加速期(CML-AP)1例,慢性髓性白血病急变期(Bc)10例;7例行HLA配型完全相合同胞间移植,7例行HLA配型不相合亲缘移植;采用重组人粒细胞集落刺激因子(rhG-CSF)动员的骨髓(BM)加外周血干细胞(PBSC)混合移植8例,单用PBSC移植6例;10例患者给予预防或治疗性rhG-CSF动员后的供者淋巴细胞输注(DLI).结果 所有病例均达到完全供者型造血重建,移植后中性粒细胞和血小板植活的中位时间分别为16 d和13 d;发生Ⅱ度急性移植物抗宿主病(aGVHD)7例,Ⅲ度aGVHD 2例,局限型慢性移植物抗宿主病(cGVHD)4例,广泛型cGVHD 6例;血液学复发9例;无早期移植相关死亡.结论 联合应用多种方法预防白血病复发,HSCT可作为IM耐药Ph(+)白血病患者重要的挽救治疗选择.
    목적 탐토조혈간세포이식(HSCT)작위갑광산이마체니(IM)내약적비성염색체양성(Ph+)백혈병만구성치료적료효.방법 회고성분석2002년7월지2006년8월북경대학인민의원혈액병연구소주원적14례IM내약Ph(+)백혈병환자행이기인(allo)-HSCT적효과,기중복발/난치급성림파세포백혈병(ALL)3례,만성수성백혈병가속기(CML-AP)1례,만성수성백혈병급변기(Bc)10례;7례행HLA배형완전상합동포간이식,7례행HLA배형불상합친연이식;채용중조인립세포집락자격인자(rhG-CSF)동원적골수(BM)가외주혈간세포(PBSC)혼합이식8례,단용PBSC이식6례;10례환자급여예방혹치료성rhG-CSF동원후적공자림파세포수주(DLI).결과 소유병례균체도완전공자형조혈중건,이식후중성립세포화혈소판식활적중위시간분별위16 d화13 d;발생Ⅱ도급성이식물항숙주병(aGVHD)7례,Ⅲ도aGVHD 2례,국한형만성이식물항숙주병(cGVHD)4례,엄범형cGVHD 6례;혈액학복발9례;무조기이식상관사망.결론 연합응용다충방법예방백혈병복발,HSCT가작위IM내약Ph(+)백혈병환자중요적만구치료선택.
    Objective To investigate the effect of allogeneic hemopoietic stem cell transplantation (HSCT)in patients with acute lymphocytic leukemia(ALL)or chronic myelocytic leukemia(CML)resistant to imatinib mesylate(IM).Methods Fourteen patients ALL[n=4,au with Ph(+)chromosome] or CML(n=10.1 in acceleration phase and 4 in blastic crisis)resistant to IM received allogeneic HSCT.The hematopoietie stem cells transplanted to 7 cases were from identical sibling donors.and hematopoietic stem ceHs transplanted to the other 7 were from mimatched related donom.Eight Cash received recombinant human granulocyte-colony stimulating factor(rhG-CSF)mobilized bone marrow transplantation plus peripheral blood stem cell transplantation(PBSCT),and 6 only received PBSCT.Ten case8 were given rhG-CSF mobilized donor lymphocyte infusion(DLI)to prevent or treat relapsing.Results All patients achieved complete allogeneic engraftment and the median times of neutrophil recovery and platelet recovery were 16 and 13 days respectively.There was no treatment related death.Nine of the 14 patients developed acute graft versus host disease(GVHD),7 being in the grade Ⅱ and 2 being in grade Ⅲ;and 6 of the 13 evaluable patients developed extensive chronic GVHD.The hematological relapse Was 9.Conclusion Allo-HSCT can be an important salvage option for patients with Ph(+)chromosome with leukemia resistant to IM.
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