摘要
目的:探讨移植前BCR-ABL基因转录本水平对接受异基因造血干细胞移植的Ph阳性急性淋巴细胞白血病(Ph^+ALL)移植后无白血病生存率(LFS)和预后的影响。方法:收集2006年07月至2014年11月在我院住院治疗并接受异基因造血干细胞移植的107例Ph^+ ALL患者临床资料,分析移植前有关临床因素对移植后LFS的影响。结果:107例Ph^+ ALL患者中,男性64例,女性43例,移植中位年龄为30(7-54)岁;总复发率为35.5%(38/107),复发中位时间为移植后6.9(1.5-40.7)个月;总死亡率为36.4%(39/107),51.3%(20/39)患者死于复发,25.6%(10/39)患者死于感染,中位随访时间为移植后19.8(3.6-83.7)个月。107例中,49例移植前BCR-ABL阴性,49例移植前BCR-ABL阳性,9例BCR-ABL资料丢失。阴性患者组5年估计累积复发率(CIR)、非复发死亡率(NRM)及总体生存率(OS)分别为26.5%、29.5%及41.6%。阳性患者组5年估计CIR、NRM及OS分别为64.4%、8.9%及48.9%。移植前基因阴性组CIR显著低于阳性组(P<0.001),NRM高于阳性组(P=0.030),两组OS相近(41.6%对48.9%,P=0.497)。多因素分析提示移植前BCR-ABL+(P=0.016)及疾病状态≥CR2(P<0.001)为LFS独立危险因素,而移植年龄为影响移植后总生存主要因素(P<0.001)。结论:复发与感染为Ph^+ ALL异基因造血干细胞移植后主要死因,疾病状态≥CR2以下移植及移植前BCR-ABL+均为Ph^+ ALL异基因造血干细胞移植后LFS独立预后危险因素。
Objective： To explore the effect of BCR-ABL gene transcripts on Leukemia-free survival（ LFS） and prognosis of patients with Philadelphia chromosome positive acute lymphoblastic leukemia（ Ph^＋ ALL） after allogeneic hematopoietic stem cell transplantation（ allo-HSCT）. Methods： The clinical data of 107 cases of Ph^＋ B-ALL patients received alloHSCT from July 2 0 0 6 to November 2 0 l4 in the First Affiliated Hospital of Soochow University were collected and the relationship between the clinical characteristics and LFS after transplantation was analyzed. Results： Out of1 0 7 Ph^＋ ALL patients（ 6 4 males and 4 3 females） with a median age of 3 0（ 7 to 5 4） years old,3 5. 5 %（ 38/107） cases relapsed after transplantation within a median time of 6. 9（ 1. 5 to 40. 7） months. A total of 39（ 36. 4%） cases died within a median time of 19. 8（ 3. 6 to 83. 7） months after HSCT,of which 51. 3%（ 20/39） due to disease relapse and 25. 6%（ 10/39） due to infection. BCR-ABL gene transcripts of 49 cases turn into negative before transplantation,of which the expected 5-year cumulative incidence of relapse（ CIR）,non-relapse mortality（ NRM） and overall survival（ OS） were 26. 5%,29. 5% and 41. 6%,respectively. Another 49 cases still had a positive BCR-ABL gene transcripts before transplantation,of which the life expectancy of 5 year CIR,NRM and OS were 64. 4%,8. 9% and 48. 9%,respectively. Compared with BCR-ABL positive patients,BCR-ABL negative patients showed a lower CIR（ P〈0. 001）,a higher NRM（ P = 0. 030） and a similar OS（ 41. 6% versus 48. 9%,P = 0. 497）. Multivariate analysis showed that BCRABL positive（ P = 0. 016） and a disease statusphase ≥CR2（ P〈0. 001） before HSCT were independent risk factors for LFS,while the age underwent HSCT was the principal element affecting prognosis（ P〈0. 001）. Conclusion： Both the relapse and infection are the main causes of death in the patients after transplantation. A disease status ≥ CR2 and the BCR-ABL positive before transplantation are 2 independent risk factors of LFS in the patients with Ph^＋ ALL after alloHSCT.
出处
《中国实验血液学杂志》
CAS
CSCD
北大核心
2017年第6期1787-1792,共6页
Journal of Experimental Hematology
基金
国家高科技研究发展计划(863计划)(2012AA02A505)
"江苏省临床医学中心"资质项目(ZX201102)
江苏高校优势学科建设工程资助项目(PAPD)
国家临床重点专科建设项目
关键词
急性淋巴细胞白血病
PH染色体
异基因造血干细胞移植
无白血病生存率
acute lymphocytic leukemia
philadelphia chromosome
allogeneic hematopoietic stem cell transplantation
leukemia-free survival
