摘要
目的:探讨用于治疗Ph+急性淋巴细胞白血病(philadelphiachromosomepositiveacutelymphoblasticleuke mia,Ph+ALL)时异基因造血干细胞移植(allogeneichematopoieticstemcelltransplantation,Allo HSCT)的时机和供者的选择。方法:总结北京大学血液病研究所自2000年3月至2004年7月采用Allo HSCT治疗Ph+ALL患者32例。其中移植前处第一次完全缓解(completeremission,CR1 )期23例,非CR1 患者9例。干细胞来源: 同胞相合供者12例,非血缘脐带血4例,非血缘志愿供者3例,HLA不合的亲缘供者13例。危险因素筛选采用COX回归分析,时间依赖的率的计算采用Kaplan Meier分析,率的比较采用Log rank检验。结果:本组患者4年存活率(overallsurvival,OS) 57. 19%, 无病存活(leukemia freesurvival, LFS) 37. 09%,复发率(relapseincidence, RI) 56. 36% 。单因素分析: 在移植前处CR1 患者组比非CR1 患者OS高(74. 50% vs22. 22% ,P=0. 004 6)、LFS高(49. 06% vs11. 11% , P=0. 005 7 )、RI低( 44. 80% vs84. 76%, P=0. 0157 ); MBCR/ABL组比mBCR/ABL组OS高( 100% vs40. 91%, P=0. 031 8)、LFS高( 75% vs17. 72%, P=0. 005 7)、RI低( 25% vs77. 88, P=0. 011 6) ;HLA不合亲缘组与HLA全合同胞组OS相近(52. 65% vs55. 56%, P=0.
Objective: To explore the optimal time of allogeneic hematopoietic stem cell transplantation(allo-HSCT) applied in patients with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph +ALL), and the optimum order of donor selection. Methods: From Mar 2000 to Jul 2004, 32 patients with Ph + ALL were treated by Allo-HSCT, and the follow up ended at Dec 30.2004 with medium of 13 months. of whom, 24 were male, and 8 were female. Twenty-three patients have been transplanted in CR_1,9 patients beyond CR_1(1 in CR_2, 8 in refractory or relapse status ). Twelve cases received HSCT from identical sibling donor,4 unrelated Cord Blood Transplantation (CBT), 3 HSCT from matched unrelated donor (MUD),and 13 HSCT from mismatched related donor (MMRD), of which, 6 cases were M BCR/ABL subtype,and 20 m BCR/ABL subtype. The Kaplan-Meier method was used to estimate the probabilities of leukemia-free survival(LFS) ,overall survival(OS) and relapse incidence(RI), and the factors were compared by means of the Log-rank test. Simultaneous effect of multiple covariates were estimated with Cox model. Results:Of all the 32 cases engrafted, 4-year OS was 57.19%, LFS 37.09%,and RI 56.36%.In univariate prognostic analysis model, the OS was higher in CR_1 group pre-HSCT than that in non-CR_1 group (74.50% vs 22.22%,P0.004 6),LFS was higher(49.06% vs 11.11%, P0.005 7), RI was lower ( 44.80% vs 84.76%, P0.015 7);the OS was higher in M BCR/ABL group than that in m BCR/ABL group (100% vs 40.91%, P0.031 8),LFS was higher ( 75% vs 17.72%, P0.005 7), RI was lower (25% vs 77.88, P0.0116);OS was similar in HLA MM RD group to that in HLA identical group(52.65% vs 55.56%, P0.624 7),LFS was similar(45.12% vs 30.00%,P 0.8315), and RI was also similar(50.77% vs 60.62%, P0.8217)。 In multiple covariate analysis model, the BCR/ABL type was the risk factor of LFS[P0.005, Exp(B)9.971]and RI(P 0.006, Exp(B)9.488), the status of disease pre-HSCT and BCR/ABL subtype was the risk factor of OS[P was 0.010 and 0.038, Exp(B) was 4.532 and 37.537 respectively].Conclusion: We had better do HSCT in CR_1 to treat Ph + ALL, if patient is refractory to chemotherapy, we can try STI571, and HSCT should be done as soon as possible if the patients get CR. Mismatched related donor is considered as regular donor for Ph +ALL patients without identical donors . We should pay more attention to monitoring and prophylaxis of relapse in m BCR/ABL patients after HSCT.
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2005年第3期231-235,共5页
Journal of Peking University:Health Sciences
