论文部分内容阅读
目的总结Ph染色体/BCR-ABL融合基因阳性急性淋巴细胞白血病(ALL)患者的临床特点。方法选取我院2009—2014年收治的37例Ph+ALL患者,均接受标准VDCP±伊马替尼(IM)诱导治疗,有合适供者的患者在第1次完全缓解(CR1)期行异基因造血干细胞移植(allo-HSCT)。无合适供者的患者继续强化巩固治疗,获得分子生物学缓解(MCR)者可选择接受自体造血干细胞移植(ASCT);其他患者继续完成再诱导、巩固、维持治疗。分析患者的无病生存(DFS)、总生存(OS)情况和复发率(RR)。结果 34例(91.2%)患者获得CR,其中1个疗程CR率为83.8%。随访至2014-01-10,共27例规范治疗的患者,中位随访时间28.8个月,DFS期和OS期分别为(21.5±3.4)、(28.8±3.6)个月。化疗组9例均复发;ASCT组4例中1例移植前后未使用IM者在移植后1a内均复发,另3例应用IM者持续MCR已达移植后13、17和27个月;alloHSCT组14例中2例死于移植并发症,3例死于复发,患者未达到中位生存时间,3aOS率(57.1±13.7)%,3aDFS率(35.7±13.3)%。结论在Ph+ALL的治疗中,allo-HSCT是年轻患者首选治疗手段,IM联合化疗可使患者及早获得并维持CR,减少复发,为患者接受allo-HSCT提供更多机会。对于无条件移植的患者,IM联合化疗能够获得较高CR,但易复发,治疗仍值得进一步探讨。
Objective To summarize the clinical features of Ph chromosome / BCR-ABL fusion gene positive acute lymphoblastic leukemia (ALL). Methods Thirty-seven patients with Ph + ALL admitted to our hospital from 2009 to 2014 were enrolled in this study. All patients undergoing standard VDCP ± imatinib (IM) induction therapy were enrolled in the first complete remission (CR1) Gene hematopoietic stem cell transplantation (allo-HSCT). Patients without suitable donors may continue intensive consolidation therapy, and those with molecular biological mitigation (MCR) may choose to receive autologous hematopoietic stem cell transplantation (ASCT); other patients continue to complete reinduction, consolidation, and maintenance treatment. Patients were analyzed for disease-free survival (DFS), overall survival (OS), and relapse rate (RR). Results Of the 34 patients (91.2%) who received CR, the CR rate of one course of treatment was 83.8%. Followed up to 2014-01-10, a total of 27 patients with normative treatment, the median follow-up time was 28.8 months, DFS and OS were (21.5 ± 3.4), (28.8 ± 3.6) months. 9 patients in the chemotherapy group relapsed; 1 patient in 4 ASCT group before and after transplantation did not use IM in 1 year after transplantation were recurrence, the other 3 patients with IM sustained MCR has reached 13,17 and 27 months after transplantation; alloHSCT group Two of 14 patients died of graft complications and 3 died of recurrence. The median survival time was not achieved in patients with 3aOS (57.1 ± 13.7%) and 3aDFS (35.7 ± 13.3%). Conclusion Allo-HSCT is the treatment of choice for young patients in the treatment of Ph + ALL. IM combined with chemotherapy can help patients obtain and maintain CR as early as possible to reduce recurrence and provide more opportunity for allo-HSCT. For unconditional transplant patients, IM combined with chemotherapy can get higher CR, but easy to relapse, the treatment is still worth further study.