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目的评价HLA相合同胞异基因造血干细胞移植(alloHSCT)治疗第1次慢性期(CP1)慢性粒细胞白血病(CML)的疗效。方法CMLCP1患者51例,采用全身照射加环磷酰胺(TBICy)或白消安加环磷酰胺(Bu/Cy)的预处理方案。移植方式为HLA相合同胞异基因外周血造血干细胞移植(PBSCT)28例,骨髓移植(BMT)23例。中位随访时间1434(60～4062)d。结果造血重建5例(98.0%),急性移植物抗宿主病(aGVHD)35例(68.6%),其中Ⅱ～Ⅳ度11例(21.6%),慢性GVHD(cGVHD)17例(37.8%),移植相关死亡8例(15.7%),复发5例(9.8%),5年无病生存率(DFS)为(79.2±6.4)%。两种预处理方案的5年DFS、死亡率及移植相关并发症差异均无显著性(值均>0.05),但Bu/Cy组复发率低(P<0.01)。两种移植方式的5年DFS、复发率及死亡率差异均无统计学意义(P值均>0.05),但alloPBSCT组cGVHD发生率高(P<0.05)。结论alloHSCT治疗CMLCP1疗效良好。预处理方案和移植方式对CMLCP1患者DFS无显著影响。供者淋巴细胞输注是治疗移植后复发的有效方法。
Objective To evaluate the efficacy of HLA-identical sibling allogeneic hematopoietic stem cell transplantation (alloHSCT) in the treatment of the first chronic phase (CP1) chronic myeloid leukemia (CML). Methods Fifty-one patients with CMLCP1 were treated with systemic irradiation plus cyclophosphamide (TBICy) or pretreatment with busulfan plus cyclophosphamide (Bu / Cy). Transplantation methods were HLA-identical sibling allogeneic peripheral blood stem cell transplantation (PBSCT) 28 cases, bone marrow transplantation (BMT) 23 cases. The median follow-up time was 1434 (60-4062) d. Results The hematopoietic reconstructions were performed in 5 cases (98.0%), 35 cases (68.6%) with acute graft-versus-host disease (AGVHD), of which 11 cases were Ⅱ ~ Ⅳ degrees and 17 cases were chronic GVHD (37.8% Eight transplant-related deaths (15.7%), five recurrences (9.8%) and a five-year disease-free survival (DFS) of (79.2 ± 6.4)% were observed. There was no significant difference in 5-year DFS, mortality and transplantation-related complications between the two pretreatment regimens (all> 0.05), but the recurrence rate was lower in the Bu / Cy group (P <0.01). There was no significant difference in 5-year DFS, relapse rate and mortality between the two transplantation methods (all P values> 0.05), but the incidence of cGVHD was significantly higher in alloPBSCT group (P <0.05). Conclusion AlloHSCT is effective in treating CMLCP1. Pretreatment and transplantation did not significantly affect DFS in patients with CMLCP1. Donor lymphocyte infusion is an effective treatment for relapse after transplantation.