与骨髓细胞相比，在急性髓系白血病患者中使用外周血干细胞进行自体移植可实现更快的植入和相当的无病生存期。

Use of peripheral blood stem cells for autologous transplantation in acute myeloid leukemia patients allows faster engraftment and equivalent disease-free survival compared with bone marrow cells.

作者信息

Visani G, Lemoli R, Tosi P, Martinelli G, Testoni N, Ricci P, Motta M, Gherlinzoni F, Leopardi G, Pastano R, Rizzi S, Piccaluga P, Isidori A, Tura S

机构信息

Institute of Haematology and Medical Oncology, 'Seragnoli', Bologna University, Bologna, Italy.

出版信息

Bone Marrow Transplant. 1999 Sep;24(5):467-72. doi: 10.1038/sj.bmt.1701920.

DOI:10.1038/sj.bmt.1701920

PMID:10482929

Abstract

We compared the feasibility and efficacy of autologous bone marrow (ABMT) and peripheral blood progenitor cell transplantation (PBSCT) performed after an identical induction/consolidation in adults with acute myeloid leukemia (AML). From January 1993 to June 1996 91 consecutive AML patients were enrolled in a program consisting of anthracycline-based induction and high-dose cytarabine consolidation (NOVIA). Until May 1994 ABMT was performed; from June 1994, if PBSC collection was adequate, PBSCT was performed. Out of 88 evaluable patients, 73 obtained a complete remission (CR) and 15 were resistant. Allogeneic bone marrow transplantation was performed in 16 patients. Forty-four (50%) were given autologous stem cell transplantation. ABMT was performed in 21 cases; twenty-nine patients were given G-CSF mobilization after NOVIA administration. An adequate number of PBSC was obtained in 23/29 (79%) cases, which were then re-infused. Median times to both neutrophil and platelet recovery from transplant were significantly shorter for the PBSC group (17 vs 36 days to 500 PMN/microl, P < 0.01; 20 vs 150 days to 20000 platelets/microl, P < 0.02; 37 vs 279 days to 50000 platelets/microl, P < 0.03), as were days of hospitalization after the reinfusion (18 vs 33, P < 0.03) and median days to transfusion independence. Toxicity was not significant in either group. After a minimum follow-up for live patients of 24 months (longer than the mean time for relapse observed for the PBSC series - 14 months) the percentage of relapses was similar: 11 of 21 (52.4%) and 12 of 23 (52.1%) in the ABMT and PBSC groups, respectively. Our results indicate that autologous PBSC transplantation, performed after an intensive chemotherapy regimen, is not inferior to ABMT in terms of disease-free survival and allows faster recovery times and reduced need for transfusion support.

摘要

我们比较了急性髓性白血病（AML）成年患者在相同诱导/巩固治疗后进行自体骨髓移植（ABMT）和外周血祖细胞移植（PBSCT）的可行性和疗效。1993年1月至1996年6月，91例连续的AML患者参加了一个由蒽环类药物诱导和大剂量阿糖胞苷巩固治疗组成的方案（NOVIA）。直到1994年5月进行ABMT；从1994年6月起，如果外周血干细胞（PBSC）采集充足，则进行PBSCT。在88例可评估患者中，73例获得完全缓解（CR），15例耐药。16例患者进行了异基因骨髓移植。44例（50%）接受了自体干细胞移植。21例进行了ABMT；29例患者在接受NOVIA治疗后给予粒细胞集落刺激因子（G-CSF）动员。23/29例（79%）获得了足够数量的PBSC，随后进行回输。PBSC组移植后中性粒细胞和血小板恢复的中位时间明显更短（至500个中性粒细胞/微升分别为17天对36天，P<0.01；至20000个血小板/微升分别为20天对150天，P<0.02；至50000个血小板/微升分别为37天对279天，P<0.03），回输后的住院天数（18天对33天，P<0.03）和输血独立的中位天数也是如此。两组的毒性均不显著。在对存活患者进行至少24个月的随访后（长于PBSC系列观察到的复发平均时间——14个月），复发率相似：ABMT组21例中有11例（52.4%），PBSC组23例中有12例（52.1%）。我们的结果表明，在强化化疗方案后进行自体PBSC移植，在无病生存期方面不劣于ABMT，且恢复时间更快，输血支持需求减少。