27例成人Ph染色体阳性急性淋巴细胞白血病的临床分析

目的：研究伊马替尼及造血干细胞移植治疗Ph＋急性淋巴细胞白血病（ALL）的临床疗效。方法收集初诊 Ph＋ALL患者27例，19例采用伊马替尼联合化疗诱导治疗（IVD组8例，伊马替尼联合VDLP组8例，伊马替尼联合VDP组3例），其余8例给予VDLP常规化疗。22例达完全缓解（CR）后给予伊马替尼联合化疗序贯治疗，3例给予常规维持及巩固化疗，定期监测血常规、骨穿、ABL基因突变及转阴情况。6例行造血干细胞移植，其中1例为自体移植。结果伊马替尼联合化疗诱导治疗C R率可达89．5％，诱导死亡率为0；常规化疗组诱导C R率为50．0％，诱导死亡率为12．5％，两组相比较，差异有统计学意义（P＜0．05）。伊马替尼联合化疗诱导治疗组中位缓解持续时间为（10．0±1．4）个月，而常规化疗组仅为2．0个月（P＜0．05）。移植患者2年总生存（OS）率75．0％，无病生存期（DFS）为83．3％；未移植患者2年OS率为14．0％，DFS率为12．6％；但两组患者OS率差异无统计学意义（P＞0．05），而DFS差异明显（P＜0．05）。BCR／ABL转阴患者的OS及DFS均明显高于未转阴患者。结论伊马替尼联合化疗诱导治疗Ph＋ALL能提高患者的CR率和缓解持续时间，造血干细胞移植能提高患者的DFS率。

Clinical analysis of 27 patients with philadelphia positive acute lymphoblastic leukemia

Objective To study the clinical effects of imatinib and hematopoietic stem cell transplantation in Ph+acute lym‐phocytic leukemia(ALL) .Methods Collecting 27 new diagnosed patients with Ph+ ALL in which 19 were assigned to induction treatment with imatinib combined with chemotherapy(8 of IVD ,8 of VDLP and imatinib ,3 of VDP and imatinib) ,the other 8 cases were treated with conventional VDLP chemotherapy .22 patients after complete remission(CR) had maintenance therapy combined with imtinib ,3 patients had maintenance therapy without imtinib .Followed‐up the blood routine examination ,bone marrow aspira‐tion and ABL fusion gene ,6 patients had hematopoietic stem cell transplantation(one was auto‐HSCT ) .Results The CR rate of imatinib combined was higher than the patients without imatinib(89 .5% vs .50 .0% ,P<0 .05) ,the induction mortality rate was al‐so higher (0 vs .12 .5% ,P<0 .05) .The median remission duration of imatinib combined and without imatinib were (10 .0 ± 1 .4) months and 2 .0 months (P<0 .05) .The disease‐free survival(DFS) was significantly longer in patients received allo‐HSCT than in those received chemotherapy only (83 .3% vs .12 .6% ,P<0 .05) ,but the 2 year overall survival(OS) rate was not significantly dif‐ferent(75 .0% vs .14 .0% ,P>0 .05) .Conclusion Imatinib is effective for the induction therapy of Ph+ ALL .The remission dura‐tion of patients who received HSCT is obviously longer than those who received chemotherapy only .