慢性粒细胞白血病异基因造血干细胞移植术后分层干预治疗疗效观察

Stratified interventional therapy for allogeneic hematopoietic stem cell transplantation in the treatment of chronic myeloid leukemia

目的:探讨慢性粒细胞白血病(CML)异基因造血干细胞移植(allo-HSCT)术后分层干预治疗的临床疗效。方法:回顾性分析我院实施allo-HSCT的19例CML患者的临床资料,其中慢性期9例,加速期3例,急变期7例;同胞全相合造血干细胞移植7例,亲缘间单倍体相合造血干细胞移植12例;均采用经重组人粒细胞刺激因子动员采集的单纯外周血造血干细胞;亲缘间单倍体相合预处理方案采用改良白消安(BU)/环磷酰胺(CY)+抗胸腺细胞球蛋白、同胞全合采用改良BU/CY;均采用短程甲氨蝶呤+环孢A+吗替麦考酚酯预防移植物抗宿主病;依据患者移植前疾病状态及移植后不同时间点BCR/ABL融合基因检测结果动态变化决定给予干预治疗措施,包括早期停用免疫抑制剂、口服敏感酪氨酸激酶抑制剂等。结果:全组19例CML患者中,3例慢性期、9例进展期(加速期+急变期)分别给予不同干预治疗措施,3例有复发倾向的慢性期患者经干预治疗均有效、9例进展期患者中2例经干预治疗无效死于疾病复发。全组患者预计2年总生存率78.9%(15/19),其中慢性期8/9例(88.9%),进展期7/10例(70.0%)。结论:对CML进行allo-HSCT术后患者,依据其移植前疾病状态不同及移植术后BCR/ABL融合基因结果的动态变化制定不同的合理分层干预治疗措施,可减少患者移植术后疾病复发率,提高患者的长期生存率及生存质量。

Objective：To explore the clinical effect of stratified interventional therapy for allogenic hematopoietic stem cell transplantation（allo-HSCT）in the treatment of chronic myeloid leukemia（CML）.Method：We retrospective analyzed clinical data of 19 patients with CML who received allo-HSCT,including 9 cases of chronic phase（CP）,3 cases of accelerated phase（AP）,7 cases of blastic phase（BP）;12 cases of haploid-matched transplantation 7 cases of sibling-matched transplantation.We adopted G-CSF mobilization of peripheral blood hematopoietic stem cells for all the patients.The pretreatment scheme was that relative haploid patients used modified BU/CY＋ATG,and sibling-matched patients used modified BU/CY.The prevention of GVHD was short period of MTX＋CSA＋MMF.After transplantation,we tested BCR/ABL fusion gene at different time points and measure the dynamic change of test results.According to the patients’ disease state before transplantation and the dynamic change of BCR/ABL fusion gene,we give patients intervention,including the early discontinuation immunosuppressants,and taking sensitive TKI,etc.Result：For all the 19 CML patients,3 cases of CP and 9 cases of AP＋BP patients were given different intervention treatment.The 3 cases of CP were effective after intervention treatment,and 2 cases of AP＋BP died of disease recurrence because of ineffective intervention treatment.The 2-years overall survival for all the patients was 78.9%（15/19）,with CP 88.9%（8/9）and AP＋BP 70.0%（7/10）.Conclusion：For the CML patients after allo-HSCT,according to patients disease state before transplantation and the dynamic change of BCR/ABL fusion gene to give different intervention treatment,can reduce the postoperative disease recurrence rate and improve the long-term survival rate and life quality of patients.