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目的探讨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)的疗效及预后因素。方法35例CML患者,11例行HLA相合同胞供者异基因骨髓移植(allo-BMT),24例行异基因外周血干细胞移植(allo-PBSCT)。全身照射(TBI)+环磷酰胺(CY)方案预处理8例,白消安(BU)+CY方案预处理27例。结果造血重建34例(97．1％),3年无病生存率(DFS)为60．0％,5年累积生存率为57．1％。复发2例,移植相关死亡12例。并发症包括出血性膀胱炎(HC)5例,肝静脉闭塞病(HVOD)1例,急性移植物抗宿主病(GVHD)18例,慢性GVHD 17例。单因素分析显示,年龄≤30岁、慢性期移植、Ⅰ和Ⅱ度急性GVHD患者3年DFS分别高于年龄>30岁、加速期移植及Ⅲ和Ⅳ度急性GVHD患者。多因素Cox回归分析结果表明,年龄、疾病状态、急性GVHD的严重程度是allo-HSCT患者长期生存的独立影响因素。结论年龄≤30岁、慢性期、轻度GVHD的CML患者行allo-HSCT治疗,可获得较高的长期生存率。
Objective To investigate the efficacy and prognosis of HLA-identical sibling donor allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the treatment of chronic myeloid leukemia (CML). Methods Thirty-five patients with CML were enrolled. Allo-BMT was performed on 11 HLA-matched siblings and 24 allogeneic peripheral blood stem cell transplantation (allo-PBSCT). Eight cases were treated with TBI + CY and 27 cases were pretreated with BU + CY. Results Thirty-four cases (97.1%) had hematopoietic reconstitution. The 3-year disease-free survival (DFS) was 60.0% and the 5-year cumulative survival rate was 57.1%. Recurrence in 2 cases, transplant-related death in 12 cases. Complications included 5 cases of hemorrhagic cystitis (HC), 1 case of hepatic veno-occlusive disease (HVOD), 18 cases of acute graft-versus-host disease (GVHD) and 17 cases of chronic GVHD. Univariate analysis showed that the 3-year DFS of patients with chronic GVHD and grade Ⅰ and Ⅱ acute GVHD were significantly higher than those of patients> 30 years of age, accelerated phase transplantation and Ⅲ and Ⅳ degree acute GVHD respectively. Multivariate Cox regression analysis showed that age, disease status, and the severity of acute GVHD were independent predictors of long-term survival in patients with allo-HSCT. Conclusions Allo-HSCT treatment for CML patients aged ≤30 years, chronic phase and mild GVHD can achieve a higher long-term survival rate.