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目的探讨Ph染色体阳性白血病患者经伊马替尼治疗后行异基因造血干细胞移植的疗效。方法回顾性分析2001年6月至2005年6月北京大学人民医院血液病研究所住院的难治性Ph染色体阳性的39例白血病患者经伊马替尼治疗后再行异基因造血干细胞移植的效果,观察伊马替尼对造血重建、移植物抗宿主病(GVHD)、总存活率(OS)、无病存活率(DFS)、复发率和移植相关并发症的影响。结果伊马替尼治疗后,18例患者血液学完全缓解,9例骨髓缓解,4例部分缓解,4例无效或疾病进展,总有效率79.49%,无重度非血液学毒性反应;移植后中性粒细胞和血小板植活中位时间分别为14d和13.5d;Ⅱ~Ⅳ度和Ⅲ~Ⅳ度急性GVHD累积发生率分别为61.53%和15.38%;根据对伊马替尼治疗的效应分为完全缓解组和未完全缓解组,其3年预期OS和DFS分别为(73.51±9.61)%对(36.36±14.50)%和(61.28±12.37)%对(31.25±13.98)%,3年累积复发率为20.41%对75.00%;4例患者死于重度移植相关并发症。结论应用伊马替尼后行异基因造血干细胞移植是一种安全、有效的治疗难治性Ph染色体阳性白血病的方法,尤其达完全缓解后行移植,可望提高此类患者的临床治愈率。
Objective To investigate the efficacy of allogeneic hematopoietic stem cell transplantation in patients with Ph chromosome positive leukemia treated with imatinib. Methods The clinical data of 39 patients with refractory Ph chromosome positive leukemia hospitalized by Institute of Hematology, Peking University People’s Hospital from June 2001 to June 2005 were retrospectively analyzed. Allogeneic hematopoietic stem cell transplantation The effects of imatinib on hematopoietic reconstitution, graft versus host disease (GVHD), overall survival (OS), disease free survival (DFS), relapse rate and transplant-related complications were observed. Results After treatment with imatinib, the hematology was completely relieved in 18 patients, the bone marrow was relieved in 9 patients, partial remission in 4 patients, ineffective in 4 patients or progression of disease, the total effective rate was 79.49%, no severe non-hematologic toxicity; The median time of engraftment of granulocytes and platelets were 14d and 13.5d, respectively. The cumulative incidence of acute GVHD of grade Ⅱ ~ Ⅳ and Ⅲ ~ Ⅳ were 61.53% and 15.38% respectively. According to the effect of imatinib treatment The 3-year expected OS and DFS were (73.51 ± 9.61)% vs (36.36 ± 14.50)% and (61.28 ± 12.37)% vs (31.25 ± 13.98%) for 3-year cumulative relapse Rates were 20.41% vs. 75.00%; 4 patients died of complications related to severe transplant. Conclusions Allogeneic hematopoietic stem cell transplantation is a safe and effective method for the treatment of refractory Ph chromosome-positive leukemia after imatinib is given, especially for complete remission after transplantation, which is expected to improve the clinical cure rate of these patients.