Alessandrino E P, Bernasconi P, Caldera D, Colombo A, Malcovati L, Martinelli G, Bonfichi M, Pagnucco G, Salvaneschi L, Bernasconi C
Istituto di Ematologia, Università di Pavia, Italy.
Bone Marrow Transplant. 1999 Mar;23(6):607-12. doi: 10.1038/sj.bmt.1701627.
Ten patients with acute leukemia (AL) in early relapse after allo-BMT were treated with a modified MEC (mitoxantrone, etoposide and Ara-C) regimen followed by donor PBPC collected after mobilization with G-CSF. Seven patients achieved CR or had normal hemopoietic reconstitution: two had an early relapse at days +53 and +48, two patients died from acute GVHD at days +31 and +96, one died of interstitial pneumonia at day +55, and two patients experienced long-term survival. One patient with refractory disease and nodal involvement who did not respond to the first BMT had overt expansion of the leukemia at day +36; one patient with Ph+ ALL and one with ANLL evolving from MDS, both with skin involvement, had blast cells in peripheral blood at day +27 and +26, respectively. Transient cytopenia occurred in all patients; a normal granulocyte and platelet count was achieved within 3 weeks in all patients but one; acute GVHD occurred in six patients, and four had chronic GVHD. This approach is feasible in patients in early relapse after allo-BMT. It assists prompt re-establishment of normal donor hematopoiesis avoiding the prolonged cytopenia observed after donor lymphocyte infusion in AL patients relapsed after allo-BMT.
10例异基因骨髓移植（allo - BMT）后早期复发的急性白血病（AL）患者接受了改良的MEC（米托蒽醌、依托泊苷和阿糖胞苷）方案治疗，随后采集经粒细胞集落刺激因子（G - CSF）动员后的供者外周血造血干细胞（PBPC）。7例患者达到完全缓解（CR）或实现了正常造血重建：2例分别在+53天和+48天早期复发，2例患者分别在+31天和+96天死于急性移植物抗宿主病（GVHD），1例在+55天死于间质性肺炎，2例患者长期存活。1例对首次BMT无反应的难治性疾病且有淋巴结受累的患者在+36天白血病明显进展；1例Ph+急性淋巴细胞白血病（ALL）患者和1例由骨髓增生异常综合征（MDS）演变而来的急性非淋巴细胞白血病（ANLL）患者，均有皮肤受累，分别在+27天和+26天外周血中出现原始细胞。所有患者均发生短暂性血细胞减少；除1例患者外，所有患者均在3周内实现粒细胞和血小板计数正常；6例患者发生急性GVHD，4例发生慢性GVHD。这种方法在allo - BMT后早期复发的患者中是可行的。它有助于迅速重建正常的供者造血，避免了allo - BMT后复发的AL患者在输注供者淋巴细胞后观察到的长期血细胞减少。
