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目的:探讨格列卫联合非清髓性单倍体造血干细胞移植在治疗慢性粒细胞白血病(CML)中的作用。方法:4例CML患者,采用移植前、后口服格列卫,以环磷酰胺、阿糖胞苷、抗胸腺细胞球蛋白、赛尼派、环胞素A等作非清髓性预处理的单倍体异基因外周血造血干细胞移植。结果:移植过程顺利,4例患者均植入成功,嵌合性植入。中性粒细胞>0.5×109/L天数,16(10~21)d;血小板>20×109/L天数,10(4~15)d。3例发生Ⅰ~Ⅱ度皮肤急性移植物抗宿主病(GVHD),1例发生Ⅳ度皮肤慢性GVHD。1例+27d死于肺部感染并多脏器功能衰竭,1例死于Ⅳ度皮肤慢性GVHD并发感染。2例无病存活(随访16个月仍健在),且Ph+染色体,bcr-abl融合基因转阴。结论:非清髓单倍体造血干细胞移植联合格列卫治疗CML,具有降低移植前白血病细胞负荷,抑制残留白血病细胞增殖,促进供者完全嵌合状态的转变,增强抗移植物白血病(GVL)效应的作用,是一种有效的治疗方法,值得进一步临床研究。
Objective: To investigate the effect of Gleevec combined with nonmyeloablative haploid hematopoietic stem cell transplantation in the treatment of chronic myeloid leukemia (CML). Methods: Four patients with CML were treated with Gleevec before and after transplantation, and nonmyeloablative pretreatment with cyclophosphamide, cytarabine, anti-thymocyte globulin, saenipid, and cyclosporin A Haploidentical Allogeneic Peripheral Blood Stem Cell Transplantation. Results: The transplantation was successful. Four patients were successfully implanted and chimerism was implanted. Neutrophils> 0.5 × 109 / L days, 16 (10 ~ 21) d; platelets> 20 × 109 / L days, 10 (4 ~ 15) d. Three cases developed Grade I ~ II acute skin graft-versus-host disease (GVHD), and one case developed grade IV chronic GVHD. One patient died of pulmonary infection and multiple organ failure in 27 days and one died of grade Ⅳ chronic GVHD infection. Two patients survived without disease (alive at 16 months of follow-up), and the Ph + chromosome and bcr-abl fusion gene turned negative. CONCLUSION: Non-myeloablative haploid hematopoietic stem cell transplantation combined with Gleevec in treatment of CML has the effects of reducing the load of pre-transplantation leukemia cells, inhibiting the proliferation of residual leukemia cells, promoting the complete chimerism of donors and enhancing the anti-allograft leukemia (GVL) Effect of the role is an effective treatment, it is worth further clinical studies.