重庆医学
重慶醫學
중경의학
Chongqing Medicine
2015年
29期
4048-4050,4053
,共4页
费城染色体%白血病 ,淋巴样%急性病%伊马替尼%造血干细胞移植
費城染色體%白血病 ,淋巴樣%急性病%伊馬替尼%造血榦細胞移植
비성염색체%백혈병 ,림파양%급성병%이마체니%조혈간세포이식
philadelphia chromosome%leukemia,lymphoid%acute disease%imatinib%hematopoietic stem cell transplantation
目的：研究伊马替尼及造血干细胞移植治疗Ph＋急性淋巴细胞白血病（ALL）的临床疗效。方法收集初诊 Ph＋ALL患者27例，19例采用伊马替尼联合化疗诱导治疗（IVD组8例，伊马替尼联合VDLP组8例，伊马替尼联合VDP组3例），其余8例给予VDLP常规化疗。22例达完全缓解（CR）后给予伊马替尼联合化疗序贯治疗，3例给予常规维持及巩固化疗，定期监测血常规、骨穿、ABL基因突变及转阴情况。6例行造血干细胞移植，其中1例为自体移植。结果伊马替尼联合化疗诱导治疗C R率可达89．5％，诱导死亡率为0；常规化疗组诱导C R率为50．0％，诱导死亡率为12．5％，两组相比较，差异有统计学意义（P＜0．05）。伊马替尼联合化疗诱导治疗组中位缓解持续时间为（10．0±1．4）个月，而常规化疗组仅为2．0个月（P＜0．05）。移植患者2年总生存（OS）率75．0％，无病生存期（DFS）为83．3％；未移植患者2年OS率为14．0％，DFS率为12．6％；但两组患者OS率差异无统计学意义（P＞0．05），而DFS差异明显（P＜0．05）。BCR／ABL转阴患者的OS及DFS均明显高于未转阴患者。结论伊马替尼联合化疗诱导治疗Ph＋ALL能提高患者的CR率和缓解持续时间，造血干细胞移植能提高患者的DFS率。
目的：研究伊馬替尼及造血榦細胞移植治療Ph＋急性淋巴細胞白血病（ALL）的臨床療效。方法收集初診 Ph＋ALL患者27例，19例採用伊馬替尼聯閤化療誘導治療（IVD組8例，伊馬替尼聯閤VDLP組8例，伊馬替尼聯閤VDP組3例），其餘8例給予VDLP常規化療。22例達完全緩解（CR）後給予伊馬替尼聯閤化療序貫治療，3例給予常規維持及鞏固化療，定期鑑測血常規、骨穿、ABL基因突變及轉陰情況。6例行造血榦細胞移植，其中1例為自體移植。結果伊馬替尼聯閤化療誘導治療C R率可達89．5％，誘導死亡率為0；常規化療組誘導C R率為50．0％，誘導死亡率為12．5％，兩組相比較，差異有統計學意義（P＜0．05）。伊馬替尼聯閤化療誘導治療組中位緩解持續時間為（10．0±1．4）箇月，而常規化療組僅為2．0箇月（P＜0．05）。移植患者2年總生存（OS）率75．0％，無病生存期（DFS）為83．3％；未移植患者2年OS率為14．0％，DFS率為12．6％；但兩組患者OS率差異無統計學意義（P＞0．05），而DFS差異明顯（P＜0．05）。BCR／ABL轉陰患者的OS及DFS均明顯高于未轉陰患者。結論伊馬替尼聯閤化療誘導治療Ph＋ALL能提高患者的CR率和緩解持續時間，造血榦細胞移植能提高患者的DFS率。
목적：연구이마체니급조혈간세포이식치료Ph＋급성림파세포백혈병（ALL）적림상료효。방법수집초진 Ph＋ALL환자27례，19례채용이마체니연합화료유도치료（IVD조8례，이마체니연합VDLP조8례，이마체니연합VDP조3례），기여8례급여VDLP상규화료。22례체완전완해（CR）후급여이마체니연합화료서관치료，3례급여상규유지급공고화료，정기감측혈상규、골천、ABL기인돌변급전음정황。6례행조혈간세포이식，기중1례위자체이식。결과이마체니연합화료유도치료C R솔가체89．5％，유도사망솔위0；상규화료조유도C R솔위50．0％，유도사망솔위12．5％，량조상비교，차이유통계학의의（P＜0．05）。이마체니연합화료유도치료조중위완해지속시간위（10．0±1．4）개월，이상규화료조부위2．0개월（P＜0．05）。이식환자2년총생존（OS）솔75．0％，무병생존기（DFS）위83．3％；미이식환자2년OS솔위14．0％，DFS솔위12．6％；단량조환자OS솔차이무통계학의의（P＞0．05），이DFS차이명현（P＜0．05）。BCR／ABL전음환자적OS급DFS균명현고우미전음환자。결론이마체니연합화료유도치료Ph＋ALL능제고환자적CR솔화완해지속시간，조혈간세포이식능제고환자적DFS솔。
Objective To study the clinical effects of imatinib and hematopoietic stem cell transplantation in Ph+acute lym‐phocytic leukemia(ALL) .Methods Collecting 27 new diagnosed patients with Ph+ ALL in which 19 were assigned to induction treatment with imatinib combined with chemotherapy(8 of IVD ,8 of VDLP and imatinib ,3 of VDP and imatinib) ,the other 8 cases were treated with conventional VDLP chemotherapy .22 patients after complete remission(CR) had maintenance therapy combined with imtinib ,3 patients had maintenance therapy without imtinib .Followed‐up the blood routine examination ,bone marrow aspira‐tion and ABL fusion gene ,6 patients had hematopoietic stem cell transplantation(one was auto‐HSCT ) .Results The CR rate of imatinib combined was higher than the patients without imatinib(89 .5% vs .50 .0% ,P<0 .05) ,the induction mortality rate was al‐so higher (0 vs .12 .5% ,P<0 .05) .The median remission duration of imatinib combined and without imatinib were (10 .0 ± 1 .4) months and 2 .0 months (P<0 .05) .The disease‐free survival(DFS) was significantly longer in patients received allo‐HSCT than in those received chemotherapy only (83 .3% vs .12 .6% ,P<0 .05) ,but the 2 year overall survival(OS) rate was not significantly dif‐ferent(75 .0% vs .14 .0% ,P>0 .05) .Conclusion Imatinib is effective for the induction therapy of Ph+ ALL .The remission dura‐tion of patients who received HSCT is obviously longer than those who received chemotherapy only .
