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加速期和急变期慢性髓系白血病(CML)患者预后较差,异基因造血干细胞移植(allo-HSCT)是这一类患者唯一具有治愈可能的治疗方法。本研究探讨allo-HSCT治疗进展期CML的疗效及预后。对1998年9月至2008年1月28例接受allo-HSCT的患者从疗效、移植前基础特点与预后、移植前治疗策略与预后、移植后事件与预后等方面进行了回顾性分析。结果表明:28例患者中10例活存并持续缓解,3年总活存率和无病活存率分别34.9%和35.7%;18例死亡。单因素分析发现,克隆演进和原始细胞比例是预后不良的基线危险因素,二者结合可以预测预后。移植前应用伊马替尼并取得完全血液学缓解并不能改善预后。对移植后事件的预后分析发现,并发重度移植物抗宿主病是预后不良的危险因素。结论:对于接受allo-HSCT治疗的进展期CML病例,克隆演进和原始细胞比例是具有预后意义,移植前应用伊马替尼并不能改善预后。
Patients with chronic myeloid leukemia (CML) at accelerated and abrupt stages have a poor prognosis and allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only cure available in this category. This study was to investigate the efficacy and prognosis of allo-HSCT in the treatment of advanced CML. From September 1998 to January 2008, 28 patients who underwent allo-HSCT were retrospectively analyzed from the following aspects: efficacy, pre-transplant characteristics and prognosis, pre-transplantation treatment strategy and prognosis, post-transplantation event and prognosis. The results showed that 10 of 28 patients survived and continued to be relieved. The 3-year overall survival rate and disease-free survival rate were 34.9% and 35.7% respectively, and 18 patients died. Univariate analysis found that the clonal evolution and the proportion of blasts were the baseline risk factors for poor prognosis. The combination of the two could predict the prognosis. The application of imatinib before transplantation and achieving complete hematologic response did not improve the prognosis. Prognostic analysis of post-transplant events found that concurrent severe graft-versus-host disease was a risk factor for poor prognosis. CONCLUSIONS: The clonal evolution and blast percentage are prognostic for advanced CML cases treated with allo-HSCT. The use of imatinib prior to transplantation did not improve prognosis.