伊马替尼联合造血干细胞移植治疗慢性粒细胞白血病

Imatinib mesylate combined with hematopiotic stem cell transplantation for chronic myloid leukemia

目的研究伊马替尼(商品名:格列卫)对异基因造血干细胞移植(allo-HSCT)和自体外周血造血干细胞移植(APBSCT)的影响。方法18例慢性粒细胞白血病(CML)分为2组:①al-lo-HSCT组14例,其中10例为CML加速期(AP)和急变期(BP),4例为CML慢性期(CP),移植前格列卫疗程中位数为25(7～60)d,供受者HLA完全相合,亲缘相关供者9例、非亲缘供者5例,预处理方案为TBI+Cy+VP16或Bu/Cy±ATG,GVHD预防按常规方案进行;②APBSC动员4例,均为CML-CP患者,格列卫治疗的中位数疗程5.5(4～26)个月,动员前反复IFISH-bcr/abl阳性率0～2%,动员方案CAE+G-CSF,其中3例经TBI+Cy+VP16预处理后进行了APBSCT。结果4例患者经G-CSF动员第5天分离自体外周血干细胞1次,得CD3+4细胞的中位数6.8(3.9～9.6)×106/kg,动员产品中I-FISH-bcr/abl阳性细胞比例高于动员前骨髓细胞(2.8%∶0.8%),4例动员PBSC的患者中3例进行了APBSCT,移植后随访中位时间24(18～28)个月,2例复发,1例持续IFISH-bcr/abl阴性。14例al-lo-HSCT患者中位随访8(4～20)个月,造血重建需要8～21d,发生GVHD8例,白血病复发2例,移植相关并发症死亡2例,复发死亡1例,无病生存9例。结论格列卫治疗后对CML患者造血干细胞的动员、移植结果无明显影响。

Objective To study the effect of imatinib combined with allogenic hematopoietic stem cell transplantation (allo-HSCT) or autologous peripheral blood stem cell transplantation (APBSCT) in chronic myeloid leukemia (CML) patients. Methods 18 CML patients were divided into 2 groups, 14 in group A and 4 in group B. Patients in group A undergone allo-HSCT, 10 were in CML accelerating phase or blast crisis, 4 were in chronic phase; among 14 patients, the median period of imatinib treatment before allo-HSCT was 25 ...