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目的:探讨格列卫联合清髓性异基因造血干细胞移植在治疗慢性髓性白血病(CML)中的作用。方法:9例CML患者(5例CP,2例为AP,2例为BP),男性,在清髓性异基因造血干细胞移植前、后口服格列卫(300~600 mg/d)治疗,移植预处理方案为BuCy2:Bu 16 mg/kg,口服(6例)或12.8 mg/kg,静脉滴注(3例)加CTX 120 mg/kg。供受者HLA配型完全相合,其中亲缘移植7例,无关供者移植2例。以霉酚酸酯联合环孢菌素A和短程MTX预防aGVHD。移植物有核细胞数5.3(3.7~8.7)×108/kg,CD34+细胞数4.8(2.8~8.5)×106/kg,粒-巨噬细胞集落形成的单位数2.8(1.9~5.3)×105/kg。结果:9例CML患者在移植前,经格列卫治疗后获完全血液学缓解(HCR)。移植后中性粒细胞>0.5×109/L中位时间12(8~26)天,血小板计数>20×109/L中位时间为20(8~25)天。移植后并发/度aGVHD3例,cGVHD4例,无早期死亡。移植后30天9例患者均获完全细胞遗传学缓解(CCR),STR检测供髓完全植入。中位随访31(7~34)月,1例治疗前CML急变患者移植后4月因复发死亡,其余病患均获完全分子学缓解(CMR),总体无病生存率88.9%。结论:清髓性异基因造血干细胞移植前、后联合格列卫治疗CML,是一种安全有效的治疗方法,值得临床进一步推广。
Objective: To investigate the effect of Gleevec combined with myeloablative allogeneic hematopoietic stem cell transplantation in the treatment of chronic myeloid leukemia (CML). Methods: Nine patients with CML (5 CPs, 2 APs and 2 BPs) were treated with Gleevec (300 ~ 600 mg / d) before and after myeloablative allogeneic hematopoietic stem cell transplantation. The transplant preconditioning regimen was BuCy2: Bu 16 mg / kg orally (6 cases) or 12.8 mg / kg intravenously (3 cases) plus CTX 120 mg / kg. Recipient HLA matching completely matched, of which 7 cases of kinship transplantation, unrelated donor transplantation in 2 cases. As mycophenolate mofetil and cyclosporine A and short-range MTX prevent aGVHD. The number of nucleated cells in the grafts was 5.3 (3.7 ~ 8.7) × 108 / kg, the number of CD34 + cells was 4.8 (2.8 ~ 8.5) × 106 / kg and the number of granulocyte - macrophage colony forming units was 2.8 kg. Results: Nine patients with CML had complete hematologic response (HCR) before treatment with Gleevec. Neutrophil transplantation> 0.5 × 109 / L median time 12 (8 ~ 26) days, platelet count> 20 × 109 / L median time was 20 (8 ~ 25) days. Concurrent / degree of graft aGVHD after transplantation 3 cases, cGVHD 4 cases, no early death. Nine days after transplantation, all 9 patients received complete cytogenetic remission (CCR) and the STRs were completely implanted into the marrow. At a median follow-up of 31 months (range, 7 to 34 months), one of the patients with CML prior to treatment died of recurrence at 4 months after transplantation, and the remaining patients achieved complete molecular response (CMR) with an overall disease-free survival rate of 88.9%. Conclusion: It is a safe and effective treatment for CML combined with Gleevec before and after myeloablative allogeneic hematopoietic stem cell transplantation. It is worth further clinical promotion.