伊马替尼联合其他化疗方案治疗Ph+急性淋巴细胞白血病

 目的 探讨伊马替尼（商品名：格列卫）联合其他化疗方案治疗Ph+急性淋巴细胞白血病（ALL）的疗效和并发症。方法 回顾性分析了6例住院Ph+ALL患者的治疗情况。除1例单用VDLP方案诱导缓解治疗外,其余5例均采用伊马替尼联合其他化疗方案诱导缓解治疗。结果 3例经伊马替尼联合其他化疗方案后获完全缓解（CR）;1例获部分缓解（PR）。2例治疗后bcr-abl基因转阴性。化疗后都发生了不同程度的感染,以呼吸道和肛周感染为主。结论 伊马替尼联合其他化疗方案治疗Ph(+)ALL有较高的缓解率,但缓解后治疗对长期生存同样重要。     

伊马替尼联合化疗治疗成年人费城染色体阳性急性淋巴细胞白血病效果分析

目的分析伊马替尼联合化疗治疗成年人费城染色体阳性(Ph^+)急性淋巴细胞白血病(ALL)的临床疗效。方法收集2012年6月至2016年1月就诊于中国医科大学附属第一医院的成年Ph^+ALL患者35例,其中联合化疗组21例,单纯化疗组14例。定期监测血常规、骨髓细胞形态学、免疫分析、染色体及融合基因等,评估疗效。联合化疗组4例患者第1次完全缓解(CR1)后行造血干细胞移植治疗。结果联合化疗组诱导治疗后完全缓解(CR)率为76%(16/21),单纯化疗组为36%(5/14),两组比较差异有统计学意义(χ^2=5.734,P=0.033)。联合化疗组(除移植患者)中位总生存(OS)时间为14个月(2~18个月),单纯化疗组5个月(0.33~10个月),两组比较差异有统计学意义(U=12.0,P=0.007)。联合化疗组中位无病生存(DFS)时间为8个月(0~15个月),单纯化疗组为2个月(0~6个月),两组比较差异有统计学意义(U=12.5,P=0.007)。4例移植患者中位OS时间26个月(22~39个月),中位DFS时间22个月(17~36个月)。结论Ph+ALL患者诱导治疗期采用伊马替尼联合化疗可提高CR率,延长DFS及OS时间,为移植赢得时间与机会。CR1后有条件者及时行造血干细胞移植治疗可延长生存时间。     

伊马替尼联合化疗序贯异基因造血干细胞移植治疗费城染色体阳性急性淋巴细胞白血病疗效的Meta分析

目的 系统评价伊马替尼联合化疗序贯异基因造血干细胞移植（allogeneic hematopoietic stem cell transplantation,allo-HSCT）治疗费城染色体阳性的急性淋巴细胞白血病（Philadelphia chromosome+acute lymphoblastic leukemia,Ph+ALL）的疗效。方法 采用Cochrane图书馆、Embase、PubMed、CNKI、CBM、Google 学术搜索等数据库,按纳入标准和排除标准筛选相关文献并提取资料、评估质量,采用RevMan 5.2软件进行Meta 分析。结果 纳入12个研究共620例患者。Meta分析显示,与非移植组比较,移植组治疗提高了患者无瘤生存率（disease free survival,DFS）（HR＝0.48, 95% CI：0.31~0.74,P<0.001）及总生存率（overall survival,OS）（HR=0.49,95% CI：0.35~0.68,P<0.001）,减少了死亡事件（RR＝0.62,95% CI：0.39~0.97,P=0.04）。结论 在伊马替尼联合化疗治疗Ph+ALL患者的基础上,序贯allo-HSCT可能优于无allo-HSCT方案。     

伊马替尼联合异基因造血干细胞移植治疗慢性粒细胞白血病急淋变三例

 目的　探讨采用伊马替尼（STI571，商品名：格列卫）联合异基因造血干细胞移植（allo-HSCT）治疗慢性粒细胞白血病（CML）急淋变的疗效。方法　3例CML急淋变患者移植前后均口服伊马替尼（200～800 mg／d）。以改良全身照射（TBI）＋环磷酰胺（Cy）或改良白消安（Bu）＋Cy为预处理方案。结果　3例患者均造血重建。3例患者均发生急性移植物抗宿主病（aGVHD），1例发生慢性GVHD（cGVHD）。2例患者复发，但最终均获得缓解。3例患者均无病生存，中位随访时间28（11～35）个月。结论　伊马替尼联合allo-HSCT治疗CML急淋变，能够降低移植前白血病细胞负荷，有利于移植后复发的治疗，是一种安全有效的治疗方法。。     

bcr-abl210＋儿童急性淋巴细胞白血病一例并文献复习

目的 探讨bcr-abl210＋儿童急性淋巴细胞白血病（ALL）的临床特征及治疗方法 .方法 回顾性分析1例bcr-abl210＋ ALL患儿的临床资料并复习文献,患儿按儿童ALL化疗方案联合伊马替尼治疗.结果 患儿口服泼尼松试验反应良好,VDLD方案诱导15 d达骨髓完全缓解,伊马替尼200 mg/d口服,按儿童ALL中危化疗方案进行巩固治疗,CAM方案早期强化治疗2个疗程,巩固治疗M方案HD-MTX＋6-MP庇护所治疗连用3次,bcr-abl210检测阴性,VDLD、CAM方案巩固治疗,bcr-abl/abl210检测阳性,bcr-abl/abl210定量0.010,伊马替尼加量为300 mg/d持续口服,化疗转入儿童高危方案HR-1、HR-2、HR-3、HR-1.2.3巩固治疗,延迟强化采用VDLD、CAM方案治疗,bcr-abl210持续阴性,进入维持治疗阶段,患儿病情稳定,多次复查骨髓均持续完全分子生物学缓解.结论 bcr-abl210＋儿童ALL的治疗可采用化疗联合伊马替尼,泼尼松试验反应良好的患者预后较好,后期治疗仍需采用高危强化疗方案,可改善患者预后.     

伊马替尼治疗bcr-abl阳性原发性血小板增多症一例并文献复习

目的 观察伊马替尼治疗bcr-abl融合基因阳性原发性血小板增多症(ET)的疗效.方法 以伊马替尼(200～400mg/d)治疗1例对羟基脲(HU)产生耐药的bcr-abl阳性ET,并复习有关文献.结果 1例bcr-abl阳性ET初始接受HU 1.5～2.0 g/d,血小板降至562×109/L;16个月后,上述剂量的HU已难以使血小板降至1000×109/L以下(1050～1330)×1 09/L;HU加量至3.0 g/d,患者白细胞降至(0.3～0.9)×109/L,而血小板为(1290～1780)×109/L;换用伊马替尼(400 mg/d)治疗1个月,患者血小板390×109/L,白细胞0.5×109/L;将伊马替尼降至200～300 mg/d,1个月后患者白细胞与血小板维持在正常水平,2个月后bcr-abl融合基因转为阴性.结论 伊马替尼可能是治疗bcr-abl阳性ET的有效靶向药物,并且bcr-abl阳性ET对低剂量伊马替尼亦是敏感的.     

实时荧光定量聚合酶链反应动态监测慢性粒细胞白血病治疗后微小残留病的研究

 【摘要】 目的 建立慢性粒细胞白血病（CML）实时荧光定量聚合酶链反应（RQ-PCR）检测方法,并研究应用此方法检测CML治疗后微小残留病（MRD）对评价MRD的意义。方法 应用RQ-PCR对80例CML患者初诊时和（或）治疗后的骨髓标本进行分析,检测bcr-abl融合基因的转录水平,回顾性分析临床资料,根据治疗方案不同分为异基因造血干细胞移植组（34例）、甲磺酸伊马替尼组（33例）、羟基脲组（13例）为,监测CML患者治疗前后bcr-abl融合基因变化。结果　RQ-PCR检测初诊CML患者bcr-abl阳性平均值为6847.67拷贝／万个细胞,加速期检测平均值为306 176.08拷贝／万个细胞;异基因造血干细胞移植组移植后1个月检测平均值为944.33拷贝／万个细胞,移植后6个月复测平均值2.37拷贝／万个细胞,移植后12个月复测平均值0.29拷贝／万个细胞,移植后24个月检测不到bcr-abl融合基因;甲磺酸伊马替尼组服用3个月后检测平均值3720.23拷贝／万个细胞,服用12个月＜0.10拷贝／万个细胞;羟基脲组用药0个月平均值7290.11拷贝／万个细胞,服用9个月后检测平均值3143.24拷贝／万个细胞。基因造血干细胞移植组、甲磺酸伊马替尼组相同时间bcr-abl水平差异无统计学意义（t＝1.74,P＝0.17）,羟基脲组与前两组间比较差异有统计学意义（t＝3.74.P＝0.01;t＝2.97,P＝0.02）。疾病进展时可检测到bcr-abl转录水平的上升;加速期患者的转录本水平明显高于慢性期患者。结论 RQ-PCR作为CML治疗后MRD检测的方法,可以评价治疗效果,预测疾病复发,早期给予干预治疗,有重要临床应用价值。     

供体淋巴细胞输注联合伊马替尼治疗异基因造血干细胞移植后Ph+白血病复发的初步临床观察

 目的 观察供体淋巴细胞输注（DLI）联合伊马替尼治疗异基因移植后复发的Ph+白血病的疗效。方法 以实时定量聚合酶链反应（RQ-PCR）及荧光原位杂交（FISH）方法检测5例Ph+白血病患者移植后微小残留病灶（MRD）,在复发早期进行DLI联合伊马替尼治疗。伊马替尼初始剂量300～400 mg／d,DLI采用递增剂量方案,首次剂量为0.5×106／kg ~ 5×106／kg,间隔时间为1 ~ 4周。观察治疗反应及相关并发症。结果 5例患者中有2例慢性髓细胞白血病（CML）患者发生分子学反应,其中1例达分子学缓解;而2例高危Ph+急性淋巴细胞白血病（Ph+ ALL）患者及1例早期血液学复发的慢性髓细胞白血病第二次慢性期（CML-CP2）患者治疗无反应。复发后随访40 d～14个月,5例应用伊马替尼后均未发生严重并发症。DLI后1例发生Ⅳ度急性移植物抗宿主病（aGVHD）,2例发生Ⅰ～Ⅱ度aGVHD,1例发生肺部感染。结论 伊马替尼联合DLI可有效治疗移植后复发的CML慢性期患者,副作用可耐受,但对复发的Ph+ ALL及CML急变期患者疗效有限。     

2012年欧洲骨髓移植登记处手册:造血干细胞移植治疗成年人急性淋巴细胞白血病

 与儿童急性淋巴细胞白血病（ALL）的5年总生存（OS）率超过80 %相比较,成年人ALL的预后令人失望,18～60岁患者的5年OS率平均仅为35 %。成年人ALL的预后较儿童差与多种因素有关,包括提示预后差的标志物,如Ph染色体阳性的发生率高,以及预后良好的亚型发生率低。由于疾病的异质性,成年人ALL需要以多种方法治疗。在过去的10～15年中,异基因造血干细胞移植（allo-HSCT）已经越来越多地被建议用于第一次完全缓解（CR1）的成年人ALL,而且配型相合的无关供者及其他替代供者也极大增加了ALL患者接受移植的机会。然而,采用allo-HSCT也必须权衡其治愈疾病的可能性与移植相关的风险,即无复发死亡（NRM）、慢性移植物抗宿主病（cGVHD）及其导致的长期存在合并疾病的可能、后期不良反应与生活质量的改变。而且,allo-HSCT应与单纯化疗一起评估。尽管已有很多的相关数据和试验,但是不同协作组报道的结论不尽相同,CR1时进行造血干细胞移植（HSCT）[无论自体HSCT（auto-HSCT）还是allo-HSCT]的适应证仍然不是很确定。一个主要的观点是推荐有HLA配型相合供者的所有ALL患者都应采用allo-HSCT,因为其有更强的免疫介导的移植物抗白血病（GVL）效应。另外一个越来越被接受的观点是通过鉴别出不需接受HSCT即可治愈的患者而只保留allo-HSCT用于高危（HR）患者。微小残留病（MRD）的评估对于界定成年人ALL危险等级有重要作用。研究热点之一是成年人ALL通过强化诱导治疗获得CR1后采用何种巩固治疗方案最好。     

bcr-abl mRNA检测在慢性粒细胞白血病诊治中的意义

 目的　探讨bcr-abl mRNA在慢性粒细胞白血病（CML）诊断、治疗及微小残留病变监测中的意义。方法　采用实时定量聚合酶链反应（real-time PCR）方法检测324例CML患者518份标本的bcr-abl mRNA表达情况。结果　CML慢性期、加速期和急变期患者的bcr-abl mRNA定量结果逐渐增高,分别为12.6 %、25.4 %和57.2 %（P＜0.05）。异基因造血干细胞移植后的bcr-abl mRNA定量结果随时间延长逐渐降低,一般在移植6个月后转阴,服用伊马替尼（商品名：格列卫）与异基因造血干细胞移植病程相似,但融合基因转阴所用时间较长。结论　real-time PCR检测bcr-abl mRNA对于诊断、评价疗效、监测微小残留病变以及预测疾病进展具有重要的临床应用价值。     

bcr-abl阳性急性淋巴细胞白血病分子生物学特点及预后分析

目的 探讨bcr-abl阳性急性淋巴细胞白血病的分子生物学特点以及在目前治疗条件下的临床疗效和预后.方法 回顾性分析2009年3月至2014年3月收治的35例初发bcr-abl阳性急性淋巴细胞白血病患者资料,比较不同化疗方案、不同转录本及移植与非移植之间达到第一次完全缓解(CR1)时间、生存及复发的差异,评价临床疗效及预后.结果 35例初发bcr-abl阳性急性淋巴细胞白血病患者中,男性21例,女性14例,中位年龄38岁(16 ～ 65岁),白细胞计数中位水平29.5×109/L(1.33× 109/L～ 192.45×109/L).转录本p190阳性26例(74.28％),mRNA中位相对表达水平0.5824(0.123 3～0.976 0),p210阳性9例(25.72％),mRNA中位相对表达水平0.623 5(0.097 4 ～ 0.959 2).中位随访12个月.35例初发患者采用4种不同的诱导化疗方案联合伊马替尼进行治疗,四组不同化疗方案达到CR1时间差异无统计学意义(P=0.518);转录本p190阳性组患者达到CR1时间较转录本p210阳性组患者延长(P=0.016),但两组总生存(P=0.167)及复发(P=0.164)均差异无统计学意义.16例患者化疗缓解后进行了异基因造血干细胞移植,移植组中位生存时间32个月(7～43个月),非移植组中位生存时间13个月(4～18个月)(P=0.017),但复发率差异无统计学意义(P=0.072).结论 在联合伊马替尼治疗条件下,不同诱导化疗方案对bcr-abl阳性急性淋巴细胞白血病疗效及预后无明显影响,转录本p190阳性患者疗效较转录本p210阳性患者差,但总生存与复发率无差异;异基因造血干细胞移植明显延长了患者的生存时间.     

Clinical effect of imatinib added to intensive combination chemotherapy for newly diagnosed Philadelphia chromosome-positive acute lymphoblastic leukemia.

Clinical impact of imatinib was evaluated in 20 patients (median age, 37 years; range, 15-67 years) with newly diagnosed Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL), who were administered with induction chemotherapy of daunorubicin, vincristine, prednisolone, and L-asparaginase, along with imatinib 600 mg/day during remission induction and 400 mg/day during consolidation courses. One patient died on day 14 from septic shock, while the remaining 19 achieved complete remission (CR). In total, 15 patients underwent allogeneic hematopoietic cell transplantation (HCT) during first CR. After median follow-up period of 799 days, six patients experienced recurrence; two with early recurrence within 100 days, one with leptomeningeal recurrence at 11 month, and three with post-HCT recurrence. Eight patients died. Median CR duration (821 days) and median patient survival (894 days) in the study were significantly longer by 2.9- and 2.3-fold, respectively, when compared to those of 18 historical patients treated with same regimen of combination chemotherapy without imatinib. Toxicities of the combined treatment were manageable and included grade 4 myelosuppression (n = 20) and reversible > or = grade 3 hyperbilirubinemia (n = 4). Beneficial clinical effects were observed when imatinib was added to combination chemotherapy in patients with newly diagnosed Ph+ ALL. Further studies with larger number of patients are necessary.     

Treatment of adult patients with Philadelphia chromosome-positive acute lymphoblastic leukemia

In the pre-imatinib era, treatment outcomes of adult patients with Philadelphia chromosome (Ph)-positive acute lymphoblastic leukemia (ALL) were dismal. Despite the use of intensive chemotherapy and allogeneic hematopoietic stem cell transplantation (HSCT), complete remission and overall survival rates were less than 70% and 20%, respectively. However, imatinib, in combination with conventional chemotherapy, has dramatically changed outcomes, producing approximately 95% complete remission and 50% overall survival with or without allogeneic HSCT. Current research is now focusing on how to prevent relapse. Improvement of postremission therapy is indispensable. Although allogeneic HSCT during first complete remission is still the first choice for feasible patients, post-HSCT imatinib therapy and imatinib plus chemotherapy combinations should also be studied. New BCR-ABL tyrosine kinase inhibitors are expected to improve outcomes in imatinib-resistant leukemia. Our hope is that, in the near future, Ph-positive ALL will become a leukemia in which allogeneic HSCT is offered only for relapsed or refractory cases.     

Efficacy and safety of imatinib mesylate (Glivec) in combination with interferon-alpha (IFN-alpha) in Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL).

Imatinib has marked antileukemic activity in advanced Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL), but secondary resistance develops rapidly, reflecting the limitations of single-agent therapy. Experimental data suggest that interferon-alpha (IFN-alpha) enhances the antileukemic activity of imatinib. We therefore examined combined imatinib and low-dose IFN-alpha in six patients with Ph+ALL who were ineligible for stem cell transplantation. All patients had received imatinib for 0.5-4.8 months prior to IFN-alpha, for relapsed (n=3) or refractory (n=1) Ph+ALL or as an alternative to chemotherapy following severe treatment-related toxicity (n=2). Five patients were in hematologic remission (CR) with minimal residual disease (MRD+), one patient was refractory to imatinib. Four of the five MRD+ patients are alive in CR after a median treatment duration of 20 (11-21) months. Two of these patients are in continuous CR 21 months after imatinib was initiated, while the other two patients experienced an isolated meningeal relapse that was successfully treated with additional intrathecal chemotherapy. Sustained molecular remissions were achieved in three patients and are ongoing 13 and 10.5 months after central nervous system (CNS) relapse and 6 months after starting concurrent IFN-alpha and imatinib, respectively. Marrow relapse occurred in one of the five MRD+ patients. Combination treatment was associated with a complete marrow response of 5 months duration in the imatinib-refractory patient. Imatinib combined with low-dose IFN-alpha may achieve prolonged hematologic and molecular remissions in a subset of patients with advanced Ph+ALL, who are not candidates for allogeneic SCT. CNS prophylaxis is necessary and may enhance the antileukemic activity of imatinib and IFN-alpha.     

Imatinib combined chemotherapy for Philadelphia chromosome-positive acute lymphoblastic leukemia: major challenges in current practice

The prognosis of Philadelphia chromosome-positive (Ph+) and/or BCR-ABL-positive acute lymphoblastic leukemia (ALL) is extremely poor, and for decades allogeneic hematopoietic stem cell transplantation (HSCT) has been considered the only option for a cure. However, the treatment for Ph+ ALL has been rapidly changing since imatinib, a selective inhibitor of the ABL tyrosine kinase, was introduced. Earlier clinical trials in which a moderate anti-leukemic effect of imatinib monotherapy was demonstrated have prompted investigators to explore the combination of imatinib and chemotherapy. The results of multiple studies indicate that chemotherapy combined with imatinib is well tolerated, induces complete hematological remission in almost every patient with newly diagnosed Ph+ ALL, and molecular remission in more than half of the cases. Future clinical studies need to focus on how imatinib can be incorporated into chemotherapy more effectively by determining the optimal dosage of imatinib, the optimal combinational schedule, and the role of allogeneic HSCT.     

Alpha-interferon improves survival and remission duration in P-190BCR-ABL positive adult acute lymphoblastic leukemia.

Treatment of P190BCR-ABL+ acute lymphoblastic leukemia (ALL) patients remains problematic: one possibility is to use biologic response modifiers such as alpha-interferon (alpha-IFN), which is known to be active in chronic myeloid leukemia (CML). We used alpha-IFN to treat 10 adult P190BCR-ABL+ ALL patients (eight newly diagnosed; two in first relapse). All received a remission induction chemotherapy (modified L-20 protocol). Patients achieving morphological, immunological and cytogenetic complete remission (CR) were then submitted to a rotational consolidation regimen lasting 6 months. When no HLA-identical donor was available, patients aged <55 years underwent stem cell harvest followed by autologous transplantation; patients aged >/=55 years received standard maintenance treatment for 6 months. In the second year, maintenance treatment (all ages) was based on cycles of alpha-IFN (3 MU three times a week for 6 weeks) alternated with methotrexate/6-mercaptopurine continuously for up to 2 years from first demonstration of CR. Thereafter, patients maintaining CR had the same schedule of alpha-IFN (6 weeks on, 6 off). Eight patients (6/8 first diagnosis, 2/2 relapsed) obtained morphological, immunological and cytogenetic CR with persistent molecular positivity. Two with an HLA-identical donor had allogeneic bone marrow transplantation. Six proceeded with chemotherapy: one experienced early relapse, three were autotransplanted, and two received maintenance. Five patients then received alpha-IFN as scheduled. All five are in continuous morphological and cytogenetic CR, with a longer mean duration of maintained morphological CR (mean 46 months; range: 20-88) than in previous reports of Ph+ ALL patients treated with chemotherapy regimens (excluding allogeneic BMT). alpha-IFN thus appears effective in this poor-risk subset of patients. This well-tolerated IFN-containing maintenance treatment could be considered to reinforce intensified programs based on autologous stem cell transplantation as an alternative to allogeneic transplantation in P190BCR-ABL+ ALL patients (and by extension for Ph+ ALL patients) lacking an HLA-matched donor. Leukemia (2000) 14, 22-27.     

Treatment of elderly patients with acute lymphoblastic leukemia--evidence for a benefit of imatinib in BCR-ABL positive patients

All patients with acute lymphoblastic leukemia (ALL) over age 60 years seen at Princess Margaret Hospital over an 11-year period were analysed retrospectively. Of 53 patients, 45 received multiagent induction chemotherapy using a variety of regimens. There were 13 BCR-ABL positive patients, 9 of who received imatinib mesylate, either during induction or post-remission therapy.

The overall complete remission (CR) rate of all 45-induction patients was 56%, with a 27% induction-related mortality rate. The CR rate was not influenced by induction regimen, age, initial WBC, LDH or BCR-ABL status. The median overall survival of the induction patients was 9 months, while the median progression-free survival (PFS) of the patients achieving CR was 10 months. The estimated overall survival (OS) at 3 years was 18.4% (95% CI: 9.8–34.3%). Age and initial WBC did not significantly predict for OS when evaluating the entire group of induction patients. However, there was a strong trend for BCR-ABL status to favorably predict for PFS, and for OS when only patients treated after July 2000 (when imatinib became available) were evaluated.

The results indicate that ALL remains a poor prognosis disease in elderly patients, and that aggressive induction regimens designed for younger patients are very toxic for these patients. These data suggest that BCR-ABL+ ALL is becoming a relatively more favorable prognosis disease in the elderly, likely due to the influence of imatinib therapy. Further regimens should explore the use of less aggressive regimens in elderly patients and should evaluate the optimal way of combining imatinib with conventional agents in BCR-ABL+ patients.     

FLAG方案治疗成年人复发难治性急性淋巴细胞白血病的疗效观察

 目的　观察FLAG方案在成年人复发难治性急性淋巴细胞白血病（ALL）诱导化疗中的疗效及安全性。方法　对2008年1月至2012年1月收治的复发难治性ALL患者（治疗组）20例,采用FLAG方案补救化疗;选择20例2002年1月至2008年1月住院的复发难治性ALL患者作为对照组,采用首次诱导方案和去甲氧柔红霉素（IDA）联合依托泊苷及大剂量甲基氢化泼尼松方案,比较两组的疗效及不良反应,应用流式细胞术（FCM）以白血病细胞特异分化抗原为标志监测两组微小残留病（MRD）,并与传统骨髓形态学结果进行比较。结果　治疗组和对照组血液学不良反应相似（P＝0.548）,治疗组其他非血液系统不良反应包括肝损伤（4／20）、心脏毒性（1／20）,较对照组（9／20 和4／20）轻;大多数不良反应均可耐受。治疗组CR 8例（40.0 %）,CR患者平均无病生存期和总生存期分别为6个月（4～30个月）和11个月（9～30个月）;对照组CR 7例（35.0 %）,CR患者平均无病生存期和总生存期分别为4个月（3～30个月）和9个月（9～30个月）,两组总生存期差异无统计学意义。治疗组早期复发率[5.0 %（1／20）]和髓外复发率（0）较对照组[20.0 %（4／20）和10.0 %（2／20）]低。结论　FLAG方案治疗成年人复发难治性ALL不良反应可耐受,为患者选择同种异基因移植争取了时间。     

异基因造血干细胞移植治疗血液肿瘤5例

目的；探讨基因造血干细胞移植对血液肿瘤的疗效。方法：采用异基因造血干细胞移植治疗血液肿瘤５例，包括２例第一次完全缓解（ＣＲ１）急性粒细胞白血病，１例ＣＲ１急性淋巴细胞白血病，１例急性粒细胞白血产现任昨发和１例非霍奇金氏淋巴瘤Ⅳ期ＣＲ１。其中异基因骨髓移植４例，异基因外周血造血干细胞移植１例。所有病例均采用ＴＢＩ＋ＣＹ＋ＣＣＮＵ作预处理。结果：所有病例均移植成功。２例发生急性移植抗宿主病，２例发生慢     

异基因造血干细胞移植是否仍是费城染色体阴性成年人急性淋巴细胞白血病第一次缓解后的首选治疗

异基因造血干细胞移植（allo-HSCT）是否仍是费城染色体阴性急性淋巴细胞白血病（Ph-ALL）成年患者首次完全缓解（CR1）后的首选治疗方案依然充满争议。最近的许多研究报道青少年和年轻成年 Ph-ALL 患者可能获益于儿童化疗方案。传统的基线危险因素并不能令人满意地预测预后，相反，早期微小残留病变（MRD）才是最佳分层工具，有助于为不同 MRD 状态的患者提供不同的治疗选择。新的治疗方法，如嵌合抗原受体（CAR）T 细胞和 blinatumomab 抗体，已经在难治、复发患者的治疗中显示出了较好的疗效。通过对儿童方案、MRD 驱动策略和新治疗方法的综合运用，可能有望改变将来治疗Ph-ALL 成年患者的模板，从而改善预后和减少不良反应。