论文部分内容阅读
背景:异基因造血干细胞移植仍是目前惟一能根治慢性粒细胞白血病的方法。随着移植技术的日臻完善,有HLA相合同胞供者的年轻慢性粒细胞白血病患者只需冒较小的近期风险,便可获得治愈疾病的远期疗效。目的:回顾性分析HLA相合同胞供者异基因造血干细胞移植治疗慢性粒细胞白血病的疗效。设计:回顾性病例分析。对象:选择2002-02/2007-12在安徽省立医院血液科住院接受异基因造血干细胞移植的慢性粒细胞白血病患者40例,男29例,女11例,中位年龄35岁;慢性期30例,加速期5例,急变期5例。供者均为HLA6/6位点配型完全相合的同胞。方法:根据移植方式进行分组:异基因骨髓移植组3例、异基因外周血干细胞移植组8例,联合组29例(异基因外周血干细胞移植+异基因骨髓移植)。预处理方案采用白消安+环磷酰胺或氟达拉滨+环磷酰胺+全身照射2Gy。移植物抗宿主病预防方案为环孢素A+霉酚酸酯。随访中位时间为移植后28个月。主要观察指标:造血功能恢复,移植相关并发症,复发及治疗转归,长期生存情况。结果:40例患者均获造血重建。40例患者中,12例(30%)发生急性移植物抗宿主病,Ⅰ度5例(13%),Ⅱ度6例(15%),Ⅲ度1例(诱发)(3%)。可评估的存活100d以上的39例患者中,15例(39%)出现慢性移植物抗宿主病。与联合组比较,异基因外周血干细胞移植组慢性移植物抗宿主病发生率明显升高(P<0.05)。40例患者中,11例发生Ⅱ度～Ⅲ度迟发性出血性膀胱炎,无急性出血性膀胱炎和肝静脉闭塞病发生。长期无病生存率80%,其中慢性期30例长期无病生存率为87%,5例急变期患者长期无病生存率为20%。加速期5例患者使用伊马替尼达到2次慢性期后进行移植,至今全部无病生存。死亡8例,其中2例死于复发,5例死于移植相关并发症,自杀1例。结论:HLA相合同胞供者异基因造血干细胞移植是治疗慢性粒细胞白血病的有效方法,尤其在慢性期移植效果较好。
BACKGROUND: Allogeneic hematopoietic stem cell transplantation is still the only method that can cure chronic myeloid leukemia. As transplantation continues to improve, younger CML patients with HLA-matched sibling donors will benefit from the long-term efficacy of cure disease with less immediate risk. Objective: To retrospectively analyze the therapeutic effect of HLA-identical sibling donor allogeneic hematopoietic stem cell transplantation on chronic myelogenous leukemia. Design: retrospective case analysis. PARTICIPANTS: Forty patients with chronic myeloid leukemia who received allogeneic hematopoietic stem cell transplantation from Department of Hematology, Anhui Provincial Hospital from February 2002 to December 2007 were selected, including 29 males and 11 females, with a median age of 35 years. Chronic 30 Cases, acceleration in 5 cases, 5 cases of blast crisis. All donors are HLA 6/6 loci with exactly the same siblings. Methods: According to the way of transplantation, 3 cases were allogeneic bone marrow transplantation group, 8 cases were allogeneic peripheral blood stem cell transplantation group and 29 cases were combined with allogeneic peripheral blood stem cell transplantation + allogeneic bone marrow transplantation. Pretreatment program using busulfan + cyclophosphamide or fludarabine + cyclophosphamide + whole body irradiation 2Gy. Graft versus host disease prophylaxis is cyclosporine A + mycophenolate. The median follow-up time was 28 months after transplantation. MAIN OUTCOME MEASURES: Hematopoietic function recovery, transplant-related complications, recurrence and treatment outcome, long-term survival. Results: All 40 patients received hematopoietic reconstitution. Of the 40 patients, acute graft versus host disease occurred in 12 patients (30%), grade I in 5 (13%), grade II in 6 (15%), and grade III in 1 (induced) (3%). Of 39 evaluable survivors over 100 days, 15 (39%) developed chronic graft versus host disease. Compared with the combined group, the incidence of chronic graft-versus-host disease in allogeneic peripheral blood stem cell transplantation group was significantly increased (P <0.05). Among the 40 patients, 11 had grade Ⅱ ~ Ⅲ delayed hemorrhagic cystitis without acute hemorrhagic cystitis and hepatic vein occlusion. Long-term disease-free survival rate of 80%, of which 30 cases of chronic long-term disease-free survival rate was 87%, 5 cases of blast crisis patients with long-term disease-free survival rate was 20%. In the accelerated phase, 5 patients were treated with imatinib and reached the second time after transplantation. All patients have survived so far. 8 died, of which 2 died of recurrence, 5 died of transplantation-related complications and 1 case of suicide. Conclusion: HLA-identical sibling donor allogeneic hematopoietic stem cell transplantation is an effective treatment for chronic myeloid leukemia, especially in chronic phase transplantation.