异基因造血干细胞移植治疗慢性粒细胞白血病63例

Allogeneic hematopoietic stem cell transplantation in the treatment of 63 patients with chronic myeloid leukemia

目的:观察异基因造血干细胞移植治疗慢性粒细胞白血病的疗效,并分析63例患者治疗后的生存状况。方法:病例来源于1989-06/2007-04在解放军总医院血液科行异基因造血干细胞移植的63例慢性粒细胞白血病患者,男52例,女11例,中位年龄33.5岁。患者均经血液形态学和细胞遗传学确诊,并对治疗知情同意。10例行HLA相合同胞供者异基因骨髓移植,39例行HLA相合同胞供者异基因外周血干细胞移植,3例行非血缘关系骨髓移植,6例行非血缘关系外周血干细胞移植,5例行HLA相合的同胞异基因非清髓外周血干细胞移植。预处理采用改良的BuCy方案和全身放疗加环磷酰胺方案。以霉酚酸酯、环孢菌素A加短疗程的甲氨喋呤预防移植物抗宿主病。移植后按每3个月定期进行随访,观察患者生存情况。结果:63例患者均完成随访,并进入结果分析。63例患者中有39例移植后5年无病存活(61.9%)。移植后100 d内死亡11例,死亡原因分别为急性移植物抗宿主病、播散性感染、复发和植入失败。移植后100d至2年内死亡12例,死亡原因分别为慢性移植物抗宿主病、巨细胞病毒感染和疾病复发。1例于移植后1413d死亡,死亡原因为慢性移植物抗宿主病合并感染。其余移植超过2年均存活。结论:异基因造血干细胞移植可使部分慢性粒细胞白血病患者获得长期无病存活。

AIM： To summarize the clinical outcome and survival of allogeneic hematopoietic stem cells transplantation in 63 patients with chronic myeloid leukemia （CML）. METHODS： Totally 63 patients with CML, who received allogeneic hematopoietic stem cell transplantation, were selected from Department of Hematology, General Hospital of Chinese PLA from June 1989 to April 2007, including 52 males and 11 females with median age of 33.5 years. All the patients were diagnosed by blood morphology and cytogenetics. They all singed the informed consent. Ten cases received allogeneic bone marrow transplantation from HLA-matched sibling donor, 39 cases received allogeneic peripheral blood stem cell transplantation from HLA-matched sibling donor, 3 cases received bone marrow transplantation from unrelated donor, 6 cases received peripheral blood stem cell transplantation （PBSCT） from unrelated donor and 5 cases received nonmyeloablative PBSCT from HLA-matched allogeneic sibling donor. Conditioning regimens were better BuCy protocol or total body irradiation （TBI） plus cyclophosphamide （CTX） protocol. Mycophenolate mofetile, cyclosporin A and short-term methotrexate were used for graft-versus-host disease （GVHD） prophylaxis. Follow-up was performed every 3 months after transplantation to observe the patients＇ survival. RESULTS： Totally 63 patients finished the follow-up and involved in the result analysis. Thirty-nine of 63 patients were alive without disease （61.9%）. Eleven patients died in 100 days after transplantation from as acute GVHD, disseminated infections, early relapse and implant failure. Twelve patients died in 100 days to 2 years after transplantation from chronic GVHD, CMV infection and disease relapse. There was no death case in two years after transplantation except 1 patient died from chronic GVHD and infection in 1 413 days after transplantation. CONCLUSION： AIIogeneic hematopoietic stem cells transplantation can make quite CML patients long disease free survival.