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目的:探讨用于治疗Ph+急性淋巴细胞白血病(philadelphiachromosomepositiveacutelymphoblasticleuke mia,Ph+ALL)时异基因造血干细胞移植(allogeneichematopoieticstemcelltransplantation,Allo HSCT)的时机和供者的选择。方法:总结北京大学血液病研究所自2000年3月至2004年7月采用Allo HSCT治疗Ph+ALL患者32例。其中移植前处第一次完全缓解(completeremission,CR1 )期23例,非CR1 患者9例。干细胞来源: 同胞相合供者12例,非血缘脐带血4例,非血缘志愿供者3例,HLA不合的亲缘供者13例。危险因素筛选采用COX回归分析,时间依赖的率的计算采用Kaplan Meier分析,率的比较采用Log rank检验。结果:本组患者4年存活率(overallsurvival,OS) 57. 19%, 无病存活(leukemia freesurvival, LFS) 37. 09%,复发率(relapseincidence, RI) 56. 36% 。单因素分析: 在移植前处CR1 患者组比非CR1 患者OS高(74. 50% vs22. 22% ,P=0. 004 6)、LFS高(49. 06% vs11. 11% , P=0. 005 7 )、RI低( 44. 80% vs84. 76%, P=0. 0157 ); MBCR/ABL组比mBCR/ABL组OS高( 100% vs40. 91%, P=0. 031 8)、LFS高( 75% vs17. 72%, P=0. 005 7)、RI低( 25% vs77. 88, P=0. 011 6) ;HLA不合亲缘组与HLA全合同胞组OS相近(52. 65% vs55. 56%, P=0. 6
Objective: To investigate the timing and donor selection of allogeneic hematopoietic stem cell transplantation (Allo HSCT) in the treatment of Ph + melamolymphaci cally lymphocytic leukemia (Ph + ALL). Methods: 32 cases of Ph + ALL patients treated with Allo HSCT from March 2000 to July 2004 in Hematology Institute of Peking University were summarized. Among them, 23 cases were complete remission (CR1) before transplantation and 9 cases were non-CR1. Source of Stem Cells: 12 cases of sibling donor, 4 cases of non-blood cord blood, 3 cases of non-blood volunteer donor and 13 cases of HLA-incompatible donor. Risk factor screening using COX regression analysis, the time-dependent rate calculation using Kaplan Meier analysis, the rate of comparison using Log rank test. Results: The 4-year overall survival rate (OS) of 57.19%, leukemia freesurvival (LFS) 37. 09%, relapseincidence (RI) 56.36%. Univariate analysis showed that patients with CR1 had significantly higher OS (74.50% vs22.22%, P = 0.00004 6), higher LFS (49.06% vs11.11%, P = 0 (100% vs40.91%, P = 0.031 8) in the MBCR / ABL group were significantly lower than those in the mBCR / ABL group (P <0.05) (25% vs77.88, P = 0.0116). The HLA-incompatible group was similar to that of the HLA-identical sibling group (52% vs77.88, P = .65% vs55. 56%, P = .6