Schey S, Ahsan G, Jones R
Department of Haematology, Kings College London, London, UK.
Bone Marrow Transplant. 1999 Nov;24(9):989-93. doi: 10.1038/sj.bmt.1702026.
Chronic lymphocytic leukaemia is a condition which has a median age of 65 years but approximately 10% of patients are younger than 50. Fludarabine has been shown to produce better response rates than conventional single agent or combination chemotherapy but as yet no improved survival. We have treated a series of 10 patients presenting with de novo (six) or relapsed (four) chronic lymphocytic leukaemia (CLL) with fludarabine as cytoreduction treatment and consolidation of the response with CD34 selected peripheral blood stem cell transplantation using cyclophosphamide and total body irradiation (TBI) as conditioning therapy. We report here on the progenitor cell harvest characteristics and clinical and molecular responses to both fludarabine and high-dose consolidation. Our results indicate that at 3 months post transplant clinical remissions were induced in 10/10 patients and molecular responses in 7/8 (88%) evaluable patients. Molecular relapses occurred on long-term follow-up at 6, 9, 12 and 24 months post transplant but patients continued in clinical and haematological remission. Two patients have died from progressive disease and a third patient from aggressive high grade lymphoma. Median survival from the time of transplantation for the group overall was 22 months (range 6-45). There was no procedure-related mortality in the first 100 days.
慢性淋巴细胞白血病患者的中位年龄为65岁，但约10%的患者年龄小于50岁。已证明氟达拉滨比传统单药或联合化疗产生更好的缓解率，但尚未改善生存率。我们用氟达拉滨作为细胞减灭治疗，并使用环磷酰胺和全身照射（TBI）作为预处理方案，通过CD34选择的外周血干细胞移植巩固反应，治疗了一系列10例初发（6例）或复发（4例）的慢性淋巴细胞白血病（CLL）患者。我们在此报告祖细胞采集特征以及对氟达拉滨和大剂量巩固治疗的临床和分子反应。我们的结果表明，移植后3个月，10/10例患者诱导出临床缓解，8例可评估患者中的7例（88%）出现分子反应。在移植后6、9、12和24个月的长期随访中出现分子复发，但患者仍处于临床和血液学缓解状态。2例患者死于疾病进展，第3例患者死于侵袭性高级别淋巴瘤。该组患者自移植时起的中位生存期为22个月（范围6 - 45个月）。前100天无与操作相关的死亡。
