Piatkowska-Jakubas B, Wegrzyn J, Rucińska M, Skotnicki A B
Kliniki Hematologii Collgium Medicum, Uniwersytetu Jagiellońskiego w Krakowie.
Przegl Lek. 1999;56 Suppl 1:52-6.
Over the past ten years considerable experience has been gained in autologous bone marrow transplantation (ABMT) for acute myelogenous leukemia and it is becoming possible to identify patients who may benefit from this approach. In acute lymphoblastic leukemia (ALL)the precise role of autologous transplantation particularly in first remission is much less clear than in AML. Formerly, most adult ALL patients who underwent ABMT did so in relapse or in second or subsequent remission. The fact that some of these patients could become long term survivors has encouraged the use of ABMT in first remission. In most studies 40-50% of first remission patients attained long term disease free survival (DFS). Relapse rates are considerably higher in patients receiving ABMT when compared to those receiving an allogeneic transplant, but the latter group of patients experience significant morbidity and mortality (15-30%) due to graft-versus-host disease and opportunistic infections. ABMT clearly has the potential to effect cures in ALL patients and its role and timing are now the subject of major clinical studies. As the mortality of ABMT for ALL rapidly decreases to approximately 5%, more widespread use of such a procedure may replace the protracted maintenance chemotherapy usually given in this disease.
在过去十年中，自体骨髓移植（ABMT）治疗急性髓细胞白血病已积累了相当多的经验，并且能够识别可能从这种治疗方法中获益的患者。在急性淋巴细胞白血病（ALL）中，自体移植的确切作用，尤其是在首次缓解期，比在急性髓细胞白血病中要模糊得多。以前，大多数接受ABMT的成年ALL患者是在复发期或第二次及后续缓解期进行移植的。这些患者中的一些能够成为长期存活者，这一事实促使人们在首次缓解期使用ABMT。在大多数研究中，40%至50%的首次缓解期患者实现了长期无病生存（DFS）。与接受异基因移植的患者相比，接受ABMT的患者复发率要高得多，但后一组患者因移植物抗宿主病和机会性感染而出现显著的发病率和死亡率（15%至30%）。ABMT显然有治愈ALL患者的潜力，其作用和时机现在是主要临床研究的主题。随着ALL的ABMT死亡率迅速降至约5%，这种治疗方法更广泛的应用可能会取代通常用于该疾病的长期维持化疗。
