Grigg A P, Szer J, Beresford J, Dodds A, Bradstock K, Durrant S, Schwarer A P, Hughes T, Herrmann R, Gibson J, Arthur C, Matthews J
The Royal Melbourne Hospital, Parkville, Victoria, Australia.
Br J Haematol. 1999 Nov;107(2):409-18. doi: 10.1046/j.1365-2141.1999.01713.x.
We evaluated the outcome of allogeneic bone marrow transplantation (BMT) for advanced acute myeloid leukaemia (AML) and acute lymphoblastic leukaemia (ALL) in 383 adult patients in nine Australian adult BMT centres between 1981 and 1997. The median overall survival for the group was 4.8 months, with an estimated 5-year survival of 18%. 28% of patients died of transplant-related toxicities within the first 100 d. Progressive disease was responsible for 48% of deaths. Multi-factor analysis demonstrated that AML (v ALL), disease status (second complete remission [CR2] v others), age (< 40 years) and duration of prior first complete remission (CR1) (> 6 months) were pre-transplant variables significantly associated with improved survival. Acute graft-versus-host disease (GVHD) of any grade reduced the rate of relapse in both AML and ALL, but only grades I-II were associated with improved survival. Both limited and extensive chronic GVHD were associated with increased survival. Only patients with AML in untreated first relapse or CR2, with a duration of CR1 > 6 months, or patients with T ALL, had a 5-year survival > 20%. Transplants for AML in induction failure or pre-B ALL in untreated first relapse or CR2 had an intermediate outcome, with 5-year survival of 10-20%. A 5-year survival of < 10% was observed for patients transplanted for ALL in induction failure or for pre-B ALL or AML in refractory first relapse or beyond CR2. These results suggest that for most adult patients with advanced acute leukaemia an allograft offers only a small chance of cure.
我们评估了1981年至1997年间澳大利亚9个成人骨髓移植中心383例成年晚期急性髓系白血病（AML）和急性淋巴细胞白血病（ALL）患者接受异基因骨髓移植（BMT）的疗效。该组患者的中位总生存期为4.8个月，估计5年生存率为18%。28%的患者在100天内死于移植相关毒性。疾病进展导致48%的死亡。多因素分析表明，AML（相对于ALL）、疾病状态（第二次完全缓解[CR2]相对于其他）、年龄（<40岁）和首次完全缓解（CR1）的持续时间（>6个月）是与生存改善显著相关的移植前变量。任何级别的急性移植物抗宿主病（GVHD）均可降低AML和ALL的复发率，但只有I-II级与生存改善相关。局限性和广泛性慢性GVHD均与生存率提高相关。只有初治首次复发或CR2期的AML患者、CR1持续时间>6个月的患者或T-ALL患者的5年生存率>20%。诱导失败的AML或初治首次复发或CR2期的前体B-ALL患者进行的移植预后中等，5年生存率为10%-20%。诱导失败的ALL患者或难治性首次复发或超过CR2期的前体B-ALL或AML患者进行移植的5年生存率<10%。这些结果表明，对于大多数成年晚期急性白血病患者，同种异体移植治愈的机会很小。
