Zander A R, Zabelina T, Kröger N, Renges H, Krüger W, Löliger C, Dürken M, Stockschläder M, de Wit M, Wacker-Backhaus G, Bielack S, Jaburg N, Rüssmann B, Erttmann R, Kabisch H
Bone Marrow Transplantation Center, University Hospital Eppendorf, Hamburg, Germany.
Bone Marrow Transplant. 1999 May;23(9):889-93. doi: 10.1038/sj.bmt.1701745.
A five-agent GVHD prophylaxis programme consisting of cyclosporin A, methotrexate, anti-thymocyte-globulin, pentaglobin and metronidazol was given to 48 recipients of unrelated donor marrow with chronic myelogenous leukemia, acute leukemia, myelodysplastic syndromes, and familiar lymphocytic hemophagocytosis of an average age of 33.5 (0.6-56) years. GVHD grades II-IV occurred in 18 patients (39%) and grades III-IV in five patients (11%). Chronic GVHD developed in nine patients (23%), three limited and six extensive. Fifteen patients died. Clinical relapse was detected in eight patients. Four patients died as a consequence of the underlying disease and subsequent treatment, 11 patients died of transplant-related causes. After a median follow-up of 19 months, the overall and disease-free survival are 67% and 62%, respectively. Survival by age is as follows: 0-19 years: 12/13 patients; 20-39 years: 14/25 patients; 40-59 years: 7/10 patients. The five-agent GVHD prophylaxis regimen is effective. Matched-unrelated donor transplants can be carried out safely in patients younger than 50 years of age. The results in patients younger than 20 years of age should encourage matched-unrelated donor transplants at earlier stages of the disease.
对48例接受非血缘供者骨髓移植的患者采用了由环孢素A、甲氨蝶呤、抗胸腺细胞球蛋白、五球蛋白和甲硝唑组成的五药预防移植物抗宿主病（GVHD）方案，这些患者患有慢性粒细胞白血病、急性白血病、骨髓增生异常综合征以及家族性淋巴细胞性噬血细胞综合征，平均年龄为33.5（0.6 - 56）岁。18例患者（39%）发生了II - IV级GVHD，5例患者（11%）发生了III - IV级GVHD。9例患者（23%）发生了慢性GVHD，其中3例为局限性，6例为广泛性。15例患者死亡。8例患者检测到临床复发。4例患者死于基础疾病及后续治疗，11例患者死于移植相关原因。中位随访19个月后，总生存率和无病生存率分别为67%和62%。按年龄划分的生存率如下：0 - 19岁：12/13例患者；20 - 39岁：14/25例患者；40 - 59岁：7/10例患者。五药预防GVHD方案是有效的。年龄小于50岁的患者可以安全地进行非血缘供者移植。20岁以下患者的结果应鼓励在疾病早期进行非血缘供者移植。
