[Effects and prognostic factors of HLA-matched sibling donor allogeneic hematopoietic stem cell transplantation for chronic myelogenous leukemia].

Objective To retrospectively analyze the curative effects and prognostic factors of HLA-matched sibling donor allogeneic hematopoietic stem cell transplantation ( allo-HSCT) for chronic myelogenous leukemia patients ( CML). Methods Of the 35 CML patients, 26 were males and 9 were females, with a median age of 32 (12-50) years. 30 patients were in chronic phase of CML, 5 patients were in accelerated phase. Allo-HSCT from HLA identical siblings was performed for 35 patients, of whom 11 received bone marrow transplantation ( BMT) and 24 peripheral blood stem cell transplantation (PBSCT). Conditioning regimens was TBI (total-body irradiation) + CY (CTX) protocol in 8 patients and BU/CY protocol in 27 patients. The average follow-up was 48 months (range 7-108 months). Results 34 (97. 1%) patients were successfully engrafted. Among them, 21 patients (60. 0%) had three years disease-free (DFS) survival. The overall 5-year survival (OS) was 57. 1%. Two patients (5. 7%) relapsed. Transplant-related mortality occurred in 12 patients. Hemorrhagic cystitis (HC) occurred in 5 patients and HVOD was observed in 1 patient. Acute graft-versus-host disease (aGVHD) occurred in 18 patients (51.4%), among them 7 patients (20. 0%) were of gradeⅢ-Ⅳ. Chronic GVHD was in 17patients (48.5% ). There was no significant difference in 3-years DFS between BMT group and PBSCT group (54.5% vs. 62. 5% ,P0.05). The 3-year disease-free survival( DFS)was 42.9% in TBI/CY group and 55.6% in BU/CY group (P 0. 05). In univariate prognostic analysis model, the DFS at 3 years is 75% and 47.4% for≤30 years patients and 30 years patients, respectively, P 0. 05. The 3-year DFS of patients with first chronic phase is higher than patients with advanced diseases (61. 3% vs. 40% , P 0.05 ) . The 3-year DFS in patients of gradeⅠ-ⅡGVHD was higher than that in patients of gradeⅢ-ⅣGVHD (81.8% vs. 14.3% ,P0.05). Conclusion The patients who had transplantation done within 1 year after diagnosis during their first chronic phase of disease and who had low-grade GVHD have better prognosis. Those patients who hadⅢ-Ⅳacute GVHD are prone to incorporate severe infection, which was a worse prognostic factor of allo-HSCT for chronic myelogenous leukemia.