酪氨酸激酶抑制剂联合化疗后行异基因造血干细胞移植治疗Ph(+)急性淋巴细胞白血病与异基因造血干细胞移植治疗Ph(−)急性淋巴细胞白血病的疗效比较

OBJECTIVE: To compare the efficacy of the Ph(+) acute lymphoblastic leukemia (ALL) patients treated with combination of tyrosine kinase inhibitors (TKI) and chemotherapy followed by allogeneic hematopoietic stem cell transplantation (allo-HSCT) and Ph(−)ALL patients with allo-HSCT. METHODS: A total of 19 Ph(+)ALL patients were matched with 19 Ph(−)ALL patients from 55 B-ALL patients receiving allo-HSCT in our hospital between January 2003 and August 2014 and were analyzed retrospectively. RESULTS: Gender, median age, number of patients with blood white count more than 30× 10(9)/L, number of patients with meningeal leukemia, disease status before allo-HSCT, period of allo-HSCT, the source of stem cell from donors, HLA disparities between donor and recipient, conditioning regimens and number of infused mononuclear cells and CD34(+) cells were comparable between two groups of Ph(+) and 19 Ph(−)ALL patients. The median time of engraftment of neutrophil cells was 12 days versus 13 days (P=0.284) and that of platelet 14 days versus 17 days (P=0.246), which were comparable between two groups. The estimated 3-year overall survival (OS) in Ph(+) and Ph-ALL groups was (67.5±12.4)% versus (74.3±11.4)% (P=0.434) and 3-year disease free survival (DFS) was (67.8±12.4)% versus (74.3±11.4)% (P=0.456), respectively. The cumulative incidence of degree Ⅱ-Ⅳ acute graft-versus-host disease (aGVHD) in Ph(+) and Ph(−)ALL group was (15.8±8.4)% versus (21.1±9.4)% (P=0.665) and that of degree Ⅲ-Ⅳ aGVHD was (5.6±5.4)% versus (11.5±7.6)% (P=0.541), respectively. The cumulative incidence of cGVHD was (44.1±14.0)% in Ph(+)ALL group versus (44.1±13.0)% in Ph(−)ALL group (P=0.835) and that of extensive cGVHD was (13.1±8.7)% versus (6.2±6.1)% (P=0.379), respectively. The cumulative relapse rate and the cumulative non-relapse rate in both group also have no statistical difference [(10.8±7.2)% versus (20.0±10.7)% (P=0.957) and (23.9±12.4)% versus (7.1±6.9)% (P=0.224), respectively]. CONCLUSION: The efficacy of Ph(+)ALL treated with combination of chemotherapy and TKIs and followed by allo-HSCT is comparable to that of Ph(−)ALL with allo-HSCT.