移植前应用伊马替尼对慢性粒细胞白血病患者造血重建及早期并发症的影响

目的 研究移植前伊马替尼治疗对慢性粒细胞白血病（CML）异基因移植患者造血重建及移植相关早期并发症的影响.方法 回顾性分析南方医科大学南方医院2003年5月至2013年5月97例行异基因移植CML患者病例资料,分为伊马替尼组（27例）与对照组（70例）,分析两组间造血重建时间、早期预后以及急性心力衰竭、肝静脉闭塞病（HVOD）、移植物抗宿主病（GVHD）、出血性膀胱炎、病原体感染等移植相关早期（＋100天）并发症发生率.结果 两组间移植后造血重建时间以及HVOD、GVHD、出血性膀胱炎、病原体感染发生率差异均无统计学意义（P＞0.05）.但伊马替尼组急性心力衰竭发生率较对照组高29.6％（8/27）比8.6％（6/70）,P=0.02],且死亡或放弃治疗事件发生率也较对照组高18.5％（5/27）比2.9％（2/70）,P=0.02].结论 移植前伊马替尼治疗可能会增加CML异基因移植患者急性心衰发生率且一定程度上影响患者预后,但对造血重建时间以及HVOD、GVHD、出血性膀胱炎、病原体感染等移植相关早期并发症发生率无明显影响.

The effects of imatinib exposure prior to allogeneic transplantation on hematopoietic reconstruction and early complications in chronic myeloid leukemia patients

Objective To investigate the effects of exposure to imatinib prior to allogeneic hematopoietic stem cell transplantation （allo-HSCT） on hematopoietic reconstruction and early transplantrelated complications for chronic myeloid leukemia （CML） patients.Methods 97 CML patients＇ clinical data who underwent allo-HSCT in Nanfang Hospital from May 2003 to May 2013 were analyzed retrospectively.The patients were divided into imatinib group （27 patients） and control group （70 patients） and their hematopoietic reconstruction time,prognosis and the incidence of early transplant-related complications （＋100 day） such as acute hearrtfailure,hepatic veno-occlusive disease （HVOD）,graft versus host disease （GVHD）,hemorrhagic cystitis and infections were compared.Results Compared with control group,imatinib group neither had a significantly longer hematopoietic reconstruction time nor higher incidence of HVOD,GVHD,hemorrhagic cystitis and infections （P 〉 0.05）.However,imatinib group tended to have a statistically higher incidence of acute hearrtfailure 29.6 % （8/27） vs 8.6 % （6/70）,P =0.02] and higher rate of mortality and withdrawal of treatment 18.5 % （5/27） vs 2.9 % （2/70）,P =0.02].Conclusions Imatinib treatment prior to transplantation probably increases the incidence of acute hearrtfailure and induces adverse prognosis.But it does not influence hematopoietic reconstruction or the incidence of early transplant-related complications such as HVOD,GVHD,hemorrhagic cystitis and infections.