伊马替尼联合造血干细胞移植治疗慢性粒细胞白血病

 目的 研究伊马替尼（商品名：格列卫）对异基因造血干细胞移植（allo-HSCT）和自体外周血造血干细胞移植（APBSCT）的影响。方法 18例慢性粒细胞白血病（CML）分为2组：①al-lo-HSCT组14例，其中10例为CML加速期（AP）和急变期（BP），4例为CML慢性期（CP），移植之前格列卫疗程中位数为25（7～60）d，供受者HLA完全相合，亲缘相关供者9例、非亲缘供者5例，预处理方案为TBI+Cy+VP16或Bu／Cy±ATG，GVHD预防按常规方案进行；②APBSC动员4例，均为CML-CP患者，格列卫治疗的中位数疗程5.5（4～26）个月，动员前反复IFISH-bcr／abl阳性率0～2%，动员方案CAE+G-CSF，其中3例经TBI+Cy+VP16预处理后进行了APBSCT。结果 4例患者经G-CSF动员第5天分离自体外周血干细胞（APBSC）1次，得CD+34细胞的中位数6.8（3.9～9.6）×106／kg，动员产品中IFISH-bcr／abl阳性细胞比例高于动员前骨髓细胞（2.8 %∶0.8 %），4例动员PBSC的患者中3例进行了APBSCT，移植后随访中位时间24（18～28）个月，2例复发，1例持续IFISH-bcr／abl阴性。14例allo-HSCT患者中位随访8（4～20）个月，造血重建需要8～21 d，发生GVHD 8例，白血病复发2例，移植相关并发症死亡2例，复发死亡1例，无病生存9例。结论 格列卫治疗后对CML患者造血干细胞的动员、移植结果无明显影响。

Imatinib mesylate combined with hematopiotic stem cell transplantation for chronic myloid leukemia

Objective To study the effect of imatinib combined with allogenic hematopoietic stem cell transplantation (allo-HSCT) or autologous peripheral blood stem cell transplantation (APBSCT) in chronic myeloid leukemia (CML) patients. Methods 18 CML patients were divided into 2 groups, 14 in group A and 4 in group B. Patients in group A undergone allo-HSCT, 10 were in CML accelerating phase or blast crisis, 4 were in chronic phase; among 14 patients, the median period of imatinib treatment before allo-HSCT was 25 d (7 ～ 60 d), 9 had related complete HLA-matched donors and 5 had unrelated complete matched donors, the regimen was TBI+Cy+VP16 or Bu/Cy±ATG, routine protocol to prevent graft versus host disease (GVHD). Patients in group B were all in chronic phase, the median period of imatinib treatment before APBSCT was 5.5 months (4 ～ 26 d), repeated negative detection of bcr/abl by IFISH, mobilization protocol was CAE+G-CSF, 3 of 4 undergone TBI+Cy+VP16 followed by APBSCT. Results In group B, 4 patients were harvested PBSC on d 5 of G-CSF mobilization, (3.9 ~ 9.6)×106/kg CD+34 cells were obtained, however, IFISH-bcr/abl postive cells in separation products increased from 0.8 % to 2.8 %. Median follow-up period after transplantation is 24 (18 ~ 28) months, 2 cases relapsed, 1 case remains IFISH-bcr/abl negative. In group A, 8 of 14 cases had GVHD, median follow-up period after transplantation is 8 (4 ~ 20) months, 2 cases relapsed, 2 cases died of trans－plantation-related complications, 1 case died of relapse, 9 cases remain disease free. Among 14 patients, hematopoietic reconstitution was on 8 ~ 21 days after transplantation. Conclusion No obvious effect of ima－tinib on the results of mobiligation and outcome of the hematopoietic stem cell transplantation in CML pa－tients.