Wang Ying, Wu Depei, Sun Aining, Jin Zhengming, Qiu Huiying, Miao Miao, Tang Xiaowen, Fu Zhengzheng
Department of Hematology, First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, 188 Shizi Sreet, 215006, Suzhou, China.
Int J Hematol. 2008 Mar;87(2):167-171. doi: 10.1007/s12185-008-0032-4. Epub 2008 Feb 22.
The prognosis for patients with chronic myeloid leukemia (CML) in blast crisis (BC) remains dismal even with the availability of the BCR-ABL tyrosine kinase inhibitor imatinib, since it only offers short-term benefit in most cases. Allogeneic hematopoietic stem cell transplantation (HSCT) seems to be a viable option for BC-CML patients who attained remission. We treated ten patients with ablative allogeneic HSCT, who achieved second chronic phase (CP) by the use of imatinib after onset of BC. Median patient age was 32 years (range 17-46). Among them, four patients received HSCT from human leukocyte antigen mismatched haplo-identical family donors. After a median follow-up of 24 months (range 8-42), six out of the ten patients were alive in durable complete cytogenetic remission, one patient died in relapse 4 months after transplantation, the others died of severe acute graft-versus-host disease and associated infections. No unusual organ toxicities and engraftment difficulties were observed. Extensive chronic GVHD developed in three of six patients who could be evaluated. Patients transplanted with haplo-identical donors had a high treatment-related modality. Allogeneic HSCT may represent a feasible treatment for patients with CML in second CP attained by imatinib after onset of BC especially when a suitable donor is available.
即使有BCR-ABL酪氨酸激酶抑制剂伊马替尼,慢性髓性白血病(CML)急变期(BC)患者的预后仍然很差,因为在大多数情况下它只提供短期益处。异基因造血干细胞移植(HSCT)似乎是达到缓解的BC-CML患者的一个可行选择。我们对10例接受清髓性异基因HSCT的患者进行了治疗,这些患者在BC发作后通过使用伊马替尼达到了第二次慢性期(CP)。患者中位年龄为32岁(范围17 - 46岁)。其中,4例患者接受了来自人类白细胞抗原不匹配的单倍体相合家庭供者的HSCT。中位随访24个月(范围8 - 42个月)后,10例患者中有6例存活且处于持久的完全细胞遗传学缓解状态,1例患者在移植后4个月复发死亡,其他患者死于严重的急性移植物抗宿主病及相关感染。未观察到异常的器官毒性和植入困难。在6例可评估的患者中,有3例发生了广泛的慢性移植物抗宿主病。接受单倍体相合供者移植的患者有较高的治疗相关死亡率。异基因HSCT对于BC发作后通过伊马替尼达到第二次CP的CML患者可能是一种可行的治疗方法,尤其是当有合适的供者时。