BCR-ABL融合基因T315I突变的白血病行异基因HSCT的疗效及复发后的治疗分析  

Curative effectiveness of ailogeneic stem cell transplantation and treatment of recurrence in patients harboring T315I BCR-ABL mutated ieukemias

作　　者：桂晓敏[1] 仇惠英[1] 潘金兰[1] 周敏[1] 鲍协炳 陈苏宁[1] 孙爱宁[1] 吴德沛[1] 岑建农[1] 沈宏杰[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血液学协同创新中心,215006

出　　处：《中华器官移植杂志》2014年第11期689-692,共4页Chinese Journal of Organ Transplantation

基　　金：江苏省科教兴卫工程-临床医学中心（ZX201102）;国家临床重点专科建设项目

摘　　要：目的分析BCR-ABL融合基因T315I突变的白血病患者接受异基因造血干细胞移植（HSCT）的资料，探讨移植疗效及复发后的治疗。方法观察10例伴T315I突变的费城染色体阳性（Ph^＋）的急性淋巴细胞白血病（ALL）和慢性粒细胞白血病（CML）接受异基因HSCT后缓解率、复发率以及长期存活情况，分析这类受者的移植疗效。结果10例受者中，男性6例，女性4例，中位年龄29岁（18-49岁），原发病为CML3例及Ph^＋ALL7例。T315I突变前服用伊马替尼5例，尼洛替尼3例，以及达沙替尼2例；10例（100％）受者在移植后均获得骨髓缓解，缓解的中位时间为23d（14～56）d。至随访截止，4例（40％）受者存活（包括1例CML和3例Ph^＋ALL）存活，目前均处于完全缓解状态（CR），存活时间为75-741d。余6例（60％）死亡，1例于移植后137d死于消化道出血，2例于移植后53d和617d死于移植物抗宿主病（GVHD），3例受者（包括1例CML和2例Ph^＋ALL受者）分别于移植后27、50和130d出现白血病复发，其中2例在复发后5d和40d死亡，1例复发后行化疗未缓解，于复发后97d死亡。结论伴T315I突变的Ph^＋ALL和CML行异基因HSCT可以获得较高的缓解率，但同时存在较高的复发风险；白血病复发的受者可以进一步采取相关治疗争取延长存活时间。Objective To retrospectively analyze the curative effectiveness of allogeneic stem cell transplantation （allo-SCT） for the leukemia patients with the T315I mutation, and to discuss the treatments for the relapsing patients after allo-SCT. Method Through observing 10 leukemia patients harboring a T315I BCR-ABL mutation who underwent allo-SCT, we analyzed the remission rate, recurrence rate and long-term survival situation of these patients and explored the treatments for relapsing patients after allo-SCT. Result Of 10 patients, 4 patients were female and 6 were male. The median age was 29 years （range, 18-49）. Before HSCT, 5 were given imatinib, 3 nilotinib and 2 dasatinib, respectively. Ten patients （100%） obtained complete remission （CR） and the median remission time was 23 days （range, 14-56）. During the follow-up period, 1 case of CML and 3 cases of Ph^＋ -ALL （40%） obtained CR. The survival time was 75 to 741 days. In the 6 dead patients, 1 died of upper gastrointestinal hemorrhage on the day 137 after allo-SCT; 2 died of graft versus host disease on the day 53 and 617 respectively after allo-SCT; 1 case of CML and 2 cases of Ph^＋ ALL relapsed on the day 27, 50 and 130 respectively after allo-SCT, and 2 of them died on the day 5 and 40 respectively after relapse, and 1 recurrent case did not obtain remission after chemotherapy and died on the day 97 after relapse. Conclusion The allo-SCT can be used to treat the leukemia patients with T315I mutation, and high remission rate can be obtained, rut there is the high risk of recurrence. The patients with recurrent leukemia can take further relevant treatment to prolong survival time.

关 键 词：T315I 白血病 异基因造血干细胞移植 复发 

分 类 号：R457.7[医药卫生—治疗学]