HLA相合同胞异基因造血干细胞移植治疗慢性粒细胞白血病第1次慢性期51例分析

目的评价HLA相合同胞异基因造血干细胞移植(alloHSCT)治疗第1次慢性期(CP1)慢性粒细胞白血病(CML)的疗效。方法CMLCP1患者51例,采用全身照射加环磷酰胺(TBICy)或白消安加环磷酰胺(Bu/Cy)的预处理方案。移植方式为HLA相合同胞异基因外周血造血干细胞移植(PBSCT)28例,骨髓移植(BMT)23例。中位随访时间1434(60～4062)d。结果造血重建5例(98.0%),急性移植物抗宿主病(aGVHD)35例(68.6%),其中Ⅱ～Ⅳ度11例(21.6%),慢性GVHD(cGVHD)17例(37.8%),移植相关死亡8例(15.7%),复发5例(9.8%),5年无病生存率(DFS)为(79.2±6.4)%。两种预处理方案的5年DFS、死亡率及移植相关并发症差异均无显著性(值均>0.05),但Bu/Cy组复发率低(P<0.01)。两种移植方式的5年DFS、复发率及死亡率差异均无统计学意义(P值均>0.05),但alloPBSCT组cGVHD发生率高(P<0.05)。结论alloHSCT治疗CMLCP1疗效良好。预处理方案和移植方式对CMLCP1患者DFS无显著影响。供者淋巴细胞输注是治疗移植后复发的有效方法。

HLA-identical sibling allogeneic hematopoietic stem cell transplantation for chronic myelogenous leukemia in first chronic phase. Analysis of 51 cases

OBJECTIVE: To evaluate the treatment outcome of HLA-identical sibling allogeneic hematopoietic stem cell transplantation (allo-HSCT) for chronic myelogenous leukemia (CML) patients in first chronic phase (CP(1)). METHODS: Fifty-one patients with CML-CP(1) received HLA-identical sibling allo-HSCT with conditioning regimens of TBI plus Cy or Bu plus Cy. Allogeneic peripheral blood stem cell transplantation (PBSCT) and bone marrow transplantation (BMT) were performed for 28 and 23 patients, respectively. The median follow-up duration was 1434 (60 - 4062) days. RESULTS: Fifty (98.0%) patients were successfully engrafted. Transplant-related mortality occurred in 8 (15.7%) patients. Acute graft-versus-host disease (aGVHD) occurred in 35 (68.6%) patients and 11 (21.6%) patients were grade II-IV, while chronic GVHD (cGVHD) did in 17 (37.8%) patients. Five (7.4%) patients relapsed. The 5-year probability of disease-free survival (DFS) was (79.2 +/- 6.4)%. There was no significant difference in 5-year DFS, death rate and treatment related syndromes between the two conditioning regimens (P > 0.05), and in 5-year DFS, relapse rate and death rate between two transplant choices (P > 0.05). However, the rate of relapse was lower in Bu/Cy group (P < 0.01) and the rate of cGVHD was higher in allo-PBSCT group (P < 0.05). CONCLUSIONS: Allo-HSCT can cure a significant proportion of patients with CML-CP(1). There was no significant difference in DFS between the two different conditioning regimens and between the different transplant choices. Donor lymphocyte infusion is a therapeutic alternative for CML patients relapsed after transplantation.