二代酪氨酸激酶抑制剂联合异基因造血干细胞移植治疗Ph染色体阳性白血病  

Second-generation tyrosine kinase inhibitors combined with allogeneic hematopoietic stem celltransplant for Philadelphia chromosome positive leukemia

作　　者：余晓[1] 李彩霞[1] 吴小津[1] 叶璐[1] 刘红[1] 马超[1] 马金凤[1] 顾彩红[1] 吴德沛[1] 

机构地区：[1]苏州大学附属第一医院、江苏省血液研究所,卫生部血栓与止血重点实验室,215006

出　　处：《中华血液学杂志》2014年第2期129-133,共5页Chinese Journal of Hematology

基　　金：江苏高校优势学科建设工程;江苏省临床医学中心（ZX201102）;江苏省科技厅生命健康科技专项（BL2012005）;国家临床重点专科建设项目

摘　　要：目的探讨二代酪氨酸激酶抑制剂（TK-Ⅱ）联合异基因造血干细胞移植（allo-HSCT）治疗高危Ph染色体阳性（Ph＋）白血病的疗效及安全性。方法对17例行allo-HSCT的高危Ph＋白血病患者进行回顾性分析，其中慢性髓性白血病（cML）8例（加速期1例、急变期7例），Ph＋急性淋巴细胞白血病（Ph＋ALL）9例。在allo-HSCT前后给予尼洛替尼或达沙替尼治疗，观察疗效及不良反应。结果所有患者均成功植人，粒系重建的中位时间为12（10～14）d，巨核系重建的中位时间为15（11～23）d。7例患者发生急性移植物抗宿主病（GvHD），其中I～Ⅱ度6例，Ⅲ度1例；6例发生慢性GVHD，均为局限型；无致死性GVHD发生。17例患者中位随访时间为17（3～60）个月，11例无病生存，6例复发，其中5例死亡。结论TK-Ⅱ联合allo-HSCT可有效提高高危Ph＋白血病患者的缓解率，减少allo-HSCT后复发，从而有助于提高高危Ph’白血病的治疗成功率。Objective To investigate the efficacy and safety of second-generation tyrosine kinase inhibitors （TK- II ） combined with allogeneic hematopoietic stem cell transplantation （allo-HSCT） in the treatment of high-risk Philadelphia chromosome positive （Ph＋） leukemia. Methods The clinical data of 17 cases of high-risk Ph＋ leukemia patients underwent allo-HSCT were retrospectively analyzed, including 1 case in accelerated phase and 7 cases in blast crises of chronic myeloid leukemia, and 9 cases of Ph＋ acute lymphoblastic leukemia. Nilotinib or Dasatinib were aderministrated before and （or） after allo-HSCT in all patients. Results All patients successfully engrafted. Median times to neutrophil and platelet recovery were 12 days （range 10-14） and 15 days （range 11-23）, respectively. Acute GVHD developed in 7 patients： 6 patient had grade 1 to 2 and 1 patient grade 3. Chronic GVHD developed in 6 patients, all were limited and no lethal GVHD occurred. At a median follow-up of 17 （range 3-60） months, 11 （64.7%） patients survived disease free, 6 patients relapsed and 5 died. Conclusion TK- 1I combined with allo- HSCT effectively improved the remission rate of high-risk Ph~ leukemia and reduced recurrence after allo- HSCT, which represented an important improvement in the treatment of patients with high-risk Ph ~ leukemia.

关 键 词：二代酪氨酸激酶抑制剂 造血干细胞移植 白血病 费城染色体 

分 类 号：R733.7[医药卫生—肿瘤]