二代TKI联合异基因造血干细胞移植或化学药物治疗Ph^+ALL的疗效比较  

Efficacy comparison of the second generation TKI combined with allogeneic hematopoietic stem cell transplantation or chemotherapy in the treatmeat of Philadelphia chromosome-positive acute lymphoblastic leukemia

作　　者：张素平[1] 万鼎铭[1] 姜中兴[1] 曹伟杰[1] 李雪[1] 李丽[1] 谢新生[1] 郭荣[1] 刘延方[1] 孙玲[1] Zhang Suping;Wan Dingming;Jiang Zhongxing;Cao Weijie;Li Xue;Li Li;Xie Xinsheng;Guo Rong;Liu Yanfang;Sun Ling(Department of Hematology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院血液内科,450052

出　　处：《中华器官移植杂志》2020年第6期346-350,共5页Chinese Journal of Organ Transplantation

摘　　要：目的比较二代酪氨酸激酶抑制剂(TKI)达沙替尼联合异基因造血干细胞移植(allo-HSCT)或化学药物治疗费城染色体阳性急性淋巴细胞白血病(Ph+ALL)的疗效差异。方法回顾分析2014年1月至2018年6月郑州大学第一附属医院血液内科收治的应用达沙替尼治疗Ph+ALL患者56例;根据是否行allo-HSCT分为移植组22例和化疗组34例,随访时间22个月(3~50个月),比较两组患者的总存活(OS)率、无病存活(DFS)率、复发及非复发死亡情况(NRM),评价联合达沙替尼治疗时,allo-HSCT是否较化疗具有优越性。结果移植组和化疗组2年OS率分别为69.1%和47.8%(P=0.032),移植组和化疗组2年DFS率分别为62.2%和43.1%(P=0.043),移植组和化疗组2年累积复发率分别为14.6%和44.1%(P=0.008),两组间2年OS、DFS和累计复发率均有统计学差异;移植组非复发死亡率(NRM)高于化疗组(分别为18.6%和14.1%),但差异无统计学意义(P=0.476)。结论达沙替尼联合allo-HSCT治疗Ph+ALL疗效优于达沙替尼联合化疗。Objective To compare the efficacy of the second generation tyrosine kinase inhibitor dasatinib combined with allogeneic hematopoietic stem cell transplantation(allo-HSCT)or chemotherapy in the treatment of Ph+acute lymphoblastic leukemia(Ph+ALL).Methods A total of 56 Ph+ALL patients received dasatinib from January 2014 to June 2018.According to whether or not allo-HSCT was performed,they were divided into transplantation group(n=22)and chemotherapy group(n=34).The total survival rate(OS),disease-free survival rate(DFS),relapse and non-recurrence mortality(NRM)were compared between two groups.Results The 2-year OS,DFS and cumulative recurrence rates were 69.1%vs 47.8%,62.2%vs 43.1%and 14.6%vs 44.1%in transplantation and chemotherapy groups respectively.Significant inter-group differences existed in 2-year DFS,DFS and cumulative recurrence rates.The value of NRM was higher in transplantation group than that in chemotherapy group(18.6%vs 14.1%).However,the difference was statistically insignificant(P=0.476).Conclusions The efficacy of dasatinib plus allo-HSCT is superior to that of dasatinib plus chemotherapy in the treatment of Ph+ALL.

关 键 词：异基因造血干细胞移植 酪氨酸激酶 费城染色体 急性淋巴细胞白血病 

分 类 号：R733.71[医药卫生—肿瘤]