【摘要】 目的：观察Ph染色体阳性急性淋巴细胞白血病(Ph~+ ALL)患者异基因造血干细胞移植后酪氨酸激酶抑制剂(TKI)维持治疗与否对移植后疗效的影响。方法：选择2012年1月1日—2020年12月31日我院血液内科收治的行异基因造血干细胞移植的Ph染色体阳性急性淋巴细胞白血病患者，移植后按照患者意愿分为TKI维持组和观察组，TKI维持组不论患者移植后BCR/ABL基因定量水平均在移植后2～6个月患者血象稳定后开始给予TKI维持治疗。观察组患者不用TKI维持治疗，直至定期监测BCR/ABL基因定量由阴性转为阳性后开始应用TKI治疗，观察两组患者移植后移植物抗宿主病(GVHD)、血液学复发、疾病无进展生存期(PFS)及总生存期(OS)的差异。结果：20例Ph~+ ALL患者移植后10例采用TKI进行维持治疗，7例移植后合并有急性GVHD及慢性GVHD。观察组患者3例Ⅳ度肠道急性GVHD,2例皮肤Ⅲ～Ⅳ级急性GVHD,1例合并有慢性GVHD。TKI维持组2例髓外乳腺复发，1例血液学复发，3例BCR/ABL融合基因一度转为阳性，更换TKI治疗后基因转为阴性。观察组患者7例复发，其中5例血液学复发，2例BCR/ABL基因阳性。TKI维持组患者截至随访结束均长期存活，观察组患者仅1例存活，其余患者均死亡。结论：移植后TKI维持治疗可以使得Ph~+ ALL患者生存获益，维持治疗最佳TKI药物及维持治疗时间尚待扩大病例数进一步研究明确。更多还原

【Abstract】 Objective: To observe the effects of tyrosine kinase inhibitors(TKI) maintenance treatment on the efficacy of allogeneic hematopoietic stem cell transplantation in patients with Ph chromosome positive acute lymphoblastic leukemia(Ph~+ ALL).Methods:From January 1 st 2012 to December 31 st 2020,Ph~+ ALL patients undergoing allogeneic hematopoietic stem cell transplantation in the department of hematology of our hospital were divided into TKI maintenance group and observation group according to the wishes of the patients after transplantation.In TKI maintenance group, regardless of the quantitative level of BCR/ABL gene after transplantation, TKI maintenance treatment was given after the patient’s hemogram was stable from 2 to 6 months after transplantation.The patients in the observation group did not need TKI maintenance treatment until the BCR/ABL gene quantification changed from negative to positive.The differences of GVHD, hematological recurrence, PFS and OS between the two groups were observed.Results:After transplantation, 10 of 20 patients with Ph~+ ALL were treated with TKI, and 7 patients were complicated with acute GVHD and chronic GVHD.3 patients in the observation group died of grade Ⅳ intestinal acute GVHD,2 patients developed skin grade Ⅲ～Ⅳ acute GVHD, and 1 patient was complicated with chronic GVHD. In TKI maintenance group, 2 cases of extramedullary breast recurrence, 1 case of hematological recurrence, 3 cases of BCR/ABL fusion gene once turned positive, and the gene turned negative after TKI replacement treatment.7 patients in the observation group relapsed, including 5 hematological relapses and 2 BCR/ABL gene positive.All patients in TKI maintenance group survived for a long time by the end of follow-up.Only 1 patient in the observation group survived, and the other patients died.Conclusion:TKI maintenance treatment after transplantation can benefit the survival of Ph~+ ALL patients.The best TKI drugs and maintenance treatment time need to be expanded and further studied.更多还原