32例成人Ph染色体阳性急性淋巴细胞白血病临床研究  

Clinical Study of 32 Patients with Adult Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia

作　　者：陈小芸[1] 郑永亮[1,2] 陈懿建[1] 

机构地区：[1]赣南医学院第一附属医院血液科,江西赣州341000 [2]南昌大学医学院研究生院,江西南昌330003

出　　处：《中国实验血液学杂志》2014年第6期1567-1571,共5页Journal of Experimental Hematology

基　　金：国家自然科学基金(81060047;81160073);江西省自然科学基金(20122BAB205024);江西省卫生厅重大项目基金(20114011)

摘　　要：本研究评价联合伊马替尼的和常规的化疗方案治疗成人Ph染色体阳性急性淋巴细胞白血病(Ph+ALL)的疗效及不良反应。回顾性分析了赣南医学院第一附属医院血液科2007年7月至2014年2月收治的32例Ph+ALL成年患者的临床资料,采用G显带技术或荧光原位杂交技术(FISH)对核型进行了分析,使用流式细胞仪检测了细胞表面的免疫标记,对比了联合伊马替尼化疗组与传统的常规化疗组之间的缓解期、生存期及不良反应。结果表明:32例Ph+ALL患者均表达B细胞及造血干/祖细胞免疫学标记;伴髓系抗原表达21例,占65.6%;遗传学分析显示,单纯Ph+27例,伴附加染色体异常5例。联用伊马替尼化疗组的DFS期为(14.3±4.7)个月,OS期为(22.6±6.8)个月;常规化疗组的DFS期为(7.2±2.9)个月,OS期为(10.7±3.8)个月。两组间的不良反应无明显差异。结论:Ph+ALL成年患者免疫表型均为B细胞,表达造血干/祖细胞抗原,常伴有髓系抗原的表达;遗传学上伴有附加染色体异常;联用伊马替尼化疗能够在不显著增加相关副反应的基础上延长非移植患者缓解期及生存期。This study was aimed to evaluate the efficacy and safety of imatinib in the treatment of patients with adult Ph chromosome-positive acute lymphoblastic leukemia（Ph^＋ ALL）.A total of 32 diagnosed adult Ph^＋ ALL patients from July 2007 to February 2014 in our hospital were retrospectively analyzed and were divided into two groupsimatinib plus chemotherapy group and traditional chemotherapy group.The differences between two groups were analysed in diseasefree survival time（DFS）,overall survival time（OS）and toxicity.The G banding technigue was used to analyse the karyotypeand the flow cytometry was applyed to detect the immune markers on suface of cells.The results showed that all patients expressed B cell and hematopietic stem /progenitor cell immune markersout of them 21 patients（65.6%）were with myeloid antigens27 patients with simple Ph（ ＋） phenotype and 5 patients with additonal chromosome abnormality.The DFS and OS of the imatinib group were statistically longer than those of the traditional chemotherapy group（ 14.3 ± 4.7 months vs 10.7 ± 3.8 months）（ P〈0.05 ）and 22.6 ± 6.8 months vs 10.7 ± 3.8 months（ P〈0.05）.There was no significant difference in toxic effects between two groups（P〉0.05）.It is concluded that the all cases of adult Ph^＋ ALL are with B cell phenotype and express hematopietic stem /progenitor cell antigen.They often accompanied by expresssion of myeloid antigens and additonal chromosome abnormality in gentics.The combination of imatinib with chemotherapy can prolong remission time and survival time for patients of non-hematopietic stem cell transplantation on the basis of no notably increasing the toxic effects.

关 键 词：PH染色体 急性淋巴细胞白血病 伊马替尼 免疫表形 治疗 预后 

分 类 号：R733.71[医药卫生—肿瘤]