Allogeneic stem cell transplantation for patients with Philadelphia positive leukemia resistant to imatinib

目的 探讨造血干细胞移植(HSCT)作为甲磺酸伊马替尼(IM)耐药的费城染色体阳性(Ph+)白血病挽救性治疗的疗效.方法 回顾性分析2002年7月至2006年8月北京大学人民医院血液病研究所住院的14例IM耐药Ph(+)白血病患者行异基因(allo)-HSCT的效果,其中复发/难治急性淋巴细胞白血病(ALL)3例,慢性髓性白血病加速期(CML-AP)1例,慢性髓性白血病急变期(Bc)10例;7例行HLA配型完全相合同胞间移植,7例行HLA配型不相合亲缘移植;采用重组人粒细胞集落刺激因子(rhG-CSF)动员的骨髓(BM)加外周血干细胞(PBSC)混合移植8例,单用PBSC移植6例;10例患者给予预防或治疗性rhG-CSF动员后的供者淋巴细胞输注(DLI).结果 所有病例均达到完全供者型造血重建,移植后中性粒细胞和血小板植活的中位时间分别为16 d和13 d;发生Ⅱ度急性移植物抗宿主病(aGVHD)7例,Ⅲ度aGVHD 2例,局限型慢性移植物抗宿主病(cGVHD)4例,广泛型cGVHD 6例;血液学复发9例;无早期移植相关死亡.结论 联合应用多种方法预防白血病复发,HSCT可作为IM耐药Ph(+)白血病患者重要的挽救治疗选择.To investigate the effect of allogeneic hemopoietic stem cell transplantation (HSCT) in patients with acute lymphocytic leukemia (ALL) or chronic myelocytic leukemia (CML) resistant to imatinib mesylate (IM).Fourteen patients with ALL [n=4, all with Ph (+) chromosome] or CML (n=10, 1 in acceleration phase and 4 in blastic crisis) resistant to IM received allogeneic HSCT. The hematopoietic stem cells transplanted to 7 cases were from identical sibling donors, and hematopoietic stem cells transplanted to the other 7 were from mismatched related donors. Eight cases received recombinant human granulocyte-colony stimulating factor (rhG-CSF) mobilized bone marrow transplantation plus peripheral blood stem cell transplantation (PBSCT), and 6 only received PBSCT. Ten cases were given rhG-CSF mobilized donor lymphocyte infusion (DLI) to prevent or treat relapsing.All patients achieved complete allogeneic engraftment and the median times of neutrophil recovery and platelet recovery were 16 and 13 days respectively. There was no treatment related death. Nine of the 14 patients developed acute graft versus host disease (GVHD), 7 being in the grade II and 2 being in grade III; and 6 of the 13 evaluable patients developed extensive chronic GVHD. The hematological relapse was 9.Allo-HSCT can be an important salvage option for patients with Ph (+) chromosome with leukemia resistant to IM.PubMed中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)0281974-19778