异基因造血干细胞移植治疗进展期慢性髓系白血病疗效及预后的初步分析

Preliminary Analysis of Therapeutic Efficacy and Prognosis of Allogeneic Hematopoietic Stem Cell Transplantation in Patients with Advanced Chronic Myeloid Leukemia

加速期和急变期慢性髓系白血病(CML)患者预后较差,异基因造血干细胞移植(allo-HSCT)是这一类患者唯一具有治愈可能的治疗方法。本研究探讨allo-HSCT治疗进展期CML的疗效及预后。对1998年9月至2008年1月28例接受allo-HSCT的患者从疗效、移植前基础特点与预后、移植前治疗策略与预后、移植后事件与预后等方面进行了回顾性分析。结果表明:28例患者中10例活存并持续缓解,3年总活存率和无病活存率分别34.9%和35.7%;18例死亡。单因素分析发现,克隆演进和原始细胞比例是预后不良的基线危险因素,二者结合可以预测预后。移植前应用伊马替尼并取得完全血液学缓解并不能改善预后。对移植后事件的预后分析发现,并发重度移植物抗宿主病是预后不良的危险因素。结论:对于接受allo-HSCT治疗的进展期CML病例,克隆演进和原始细胞比例是具有预后意义,移植前应用伊马替尼并不能改善预后。

Chronic myeloid leukemia（CML） at advanced and blastic phase is a disease with poor prognosis,for which allogeneic hematopoietic stem cell transplantation（allo-HSCT） is the only treatment choice with curative potential.This study was purposed to investigate the therapeutic efficacy of allo-HSCT and prognosis of advanced CML patients.The 28 cases of CML in accelerated phase or blast crisis received allo-HSCT were analysed retrospectively in terms curative efficacy,basic characteristics before transplant and prognosis,therapeutic strategy before transplant and prognosis,events after transplant and prognosis.The results indicated that 10 out of 28 patients were in complete remission,showing a 3-year overall survival and disease-free survaval rate of 34.9% and 35.7% respectively;18 patients died.Univariate analysis revealed that the clonal evolution and blast amount are baseline risk factor of poor prognosis,and combination of them can be used to predict the outcome of patients;application of imatinib before transplant and achievement of complete hematologic remission could not improve the prognosis;seveve aGVHD among post-transplant events was proven to be a negative prognostic factor.It is concluded that for advanced CML patients received allo-HSCT,clonal evolution and blast percentage are prognostic factors,and the pre-transplant use of imatinib did not influence the outcome.