Stratified interventional therapy for allogeneic hematopoietic stem cell transplantation in the treatment of chronic myeloid leukemia
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摘要: 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。
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关键词:
- 慢性粒细胞白血病 /
- 异基因造血干细胞移植 /
- 干预治疗
Abstract: 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. -
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