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目的 探讨非清髓造血干细胞移植联合伊马替尼(格列卫、STI571)在治疗慢性粒细胞白血病(CML)中的作用。方法 10例CML患者中3例为慢性期,4例为加速期,3例为急变期。移植前、后口服格列卫(400～1500mg/d)治疗,预处理方案为福达拉宾,环磷酰胺和阿糖胞苷联合抗胸腺细胞球蛋白或CD3单抗。供者HLA配型4例完全相合,2例1个位点不相合,1例2个位点不相合的同胞,1例3个位点不相合的同胞及2例半匹配的母亲供者。干细胞来源为重组人类粒细胞集落刺激因子(rhG- CSF,格拉诺赛特)动员的外周血造血干细胞(PBSC),移植物抗宿主病(GVHD)的预防以环孢菌素A和霉酚酸酯(骁悉)为主,部分病例加用甲氨蝶呤、CD3单抗及CD25单抗(塞尼派)。结果 10例患者均获得不同程度的嵌合状态,3例获得完全嵌合(>95%),7例获得44%～95%的混合嵌合。7例混合嵌合状态的患者经调整免疫抑制剂、供者淋巴细胞/PBSC输注,格列卫治疗,6例患者在移植后1 5～10个月转变为完全嵌合。移植后中性粒细胞>0. 5×109/L所需天数为16d(10～21d);血小板大于20×109/L所需天数为10d(4～15d)。移植期间1例患者移植后45d因肠道感染,颅内出血死亡。另1例患者移植后27d因多脏器衰竭死亡。8例患者随访7～23个月,6例发生Ⅰ～Ⅱ度GVHD,2例发生Ⅲ～Ⅳ度GVHD,除1例因慢性GVHD死?
Objective To investigate the role of non-myeloablative hematopoietic stem cell transplantation combined with imatinib (Gleevec, STI571) in the treatment of chronic myelogenous leukemia (CML). Methods Three patients with chronic myeloid leukemia (CML) were treated with chronic phase, four with accelerated phase and three with acute phase. Before and after transplantation, the treatment of oral Gleevec (400 ~ 1500mg / d), pretreatment program for the Fuda Rabin, cyclophosphamide and cytarabine combined anti-thymocyte globulin or CD3 monoclonal antibody. There were 4 cases of donor HLA matching, 2 cases of 1 mismatch, 1 case of 2 mismatched siblings, 1 case of 3 mismatched siblings and 2 cases of semi-matched mother donor. Prevention of graft-versus-host disease (GVHD) by stem cells from peripheral blood stem cells (PBSCs) mobilized by recombinant human granulocyte colony-stimulating factor (rhG-CSF) Ester (Squad) main, in some cases with methotrexate, CD3 monoclonal antibody and CD25 monoclonal antibody (Nepalese). Results All 10 patients had different degrees of chimerism, 3 cases got complete chimerism (> 95%) and 7 cases got 44% ~ 95% chimerism. Seven patients with mixed chimerism were treated with immunosuppressant, donor lymphocyte / PBSC infusion and Gleevec treatment, and 6 patients changed to complete chimerism 15 to 10 months after transplantation. The number of days required for neutrophil engraftment> 0.5 × 109 / L after transplantation was 16 days (10-21 days); the number of days required for platelets greater than 20 × 109 / L was 10 days (4-15 days). One patient died of intestinal bleeding and intracranial hemorrhage 45 days after transplantation. Another patient died of multiple organ failure 27 days after transplantation. Eight patients were followed up for 7 to 23 months. Six patients had grade Ⅰ ~ Ⅱ GVHD and two patients developed grade Ⅲ ~ Ⅳ GVHD. One patient died of chronic GVHD.