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第一次慢性期的疗效观察与成本分析

Analysis on the effect and cost of HLA-matched sibling donor aHogeneic hematopoietic stem cell transplantation for chronic myeloid leukemia in first chronic phase

目的评估HLA相合同胞供者异基因造血干细胞移植（allo-HSCT）治疗慢性粒细胞白血病（CML）第一次慢性期的疗效和卫生成本。方法回顾性分析比较30例CML第一次慢性期患者行HLA相合同胞供者allo-HSCT的疗效和治疗成本。治疗成本包括移植和移植后3年内所有供受者相关费用。结果30例均获造血重建，其中8例（26．7％）发生急性移植物抗宿主病（GVHD），11例（36．7％）出现慢性GVHD，8例发生Ⅱ度-Ⅲ度迟发性出血性膀胱炎（HC），无急性HC和肝静脉闭塞病（HVOD）发生。3年生存率82．1％。计算成本效果比，allo-HSCT挽回1例死亡所耗费成本为25．4万元，相当于我国伊马替尼（格列卫，400mg／d）10个月的治疗费用。GVHD、感染和HC与移植高费用具有显著相关性（P值均〈0．01）。结论HLA相合同胞供者allo-HSCT是治疗CML第一次慢性期的有效方法。从治疗经济学角度考虑，ano-HSCT仍可作为我国有同胞全合供者的CML患者第一次慢性期的一线治疗。

Objective To retrospectively analyze the effect and cost of HLA matched sibling donor allogeneic hematopoietic stem cell transplantation （allo-HSCT） for chronic myelogenous leukemia patients（CML） in first chronic phase. Methods 30 CML patients in first chronic phase received Allo-HSCT were analyzed retrospectively, and their therapeutic efficacy and medical cost were compared. The costs included all those transplantation and 3 year follow-up costs related to patients and donors. Results All 30 patients were successfully engrafted. Among them, acute graft versus host disease （aGVHD） occurred in 8 patients （26.7%）;chronic GVHD was in 11 patients （36.7%）;and chronic hemorhagic cystitis （HC） occurred in 8 patients. Evidence of acute hemorhagie cystitis （ HC ） and hepatic veno-occlusive disease （HVOD） could not be discovered in all 30 patients. The 3 years survival rate was 82.1%. The cost/effectiveness of allo-HSCT per patient was 254 000 RMB, an amount that is enough to cover 10 months of treatment with imatinib（400 mg per day） in China. The total costs were higher in patients with graft-versus host disease, infection or HC （ P 〈 0. 01, respectively ）. Conclusion HLA matched sibling donor allogeneie HSCT is a curative form of treatment for patients with CML in first chronic period. Financial considerations may favor HLA-matched sibling donor allo-HSCT as a first-line therapy for CML in first chronic phase in China.