Ringdén O, Labopin M, Gorin N C, Schmitz N, Schaefer U W, Prentice H G, Bergmann L, Jouet J P, Mandelli F, Blaise D, Fouillard L, Frassoni F
Centre for Allogeneic Stem-cell Transplantation, Huddinge, Sweden. olle,
Br J Haematol. 2000 Dec;111(4):1130-7. doi: 10.1046/j.1365-2141.2000.02493.x.
During a 13-year period, 5200 autografts, 1039 HLA-identical sibling transplants without acute or chronic graft-vs.-host disease (GVHD) and 67 twins were reported to the European Group for Blood and Marrow Transplantation EBMT. Follow-up time was a median of 32 months. Diagnoses were acute myeloid leukaemia (AML, 4521) and acute lymphoblastic leukaemia (ALL, 1785) in first complete remission. The probability of relapse at 5 years was 51 +/- 1% in the autografts, 45 +/- 8% in the twins and 34 +/- 2% among the HLA-identical siblings (auto vs. sibs, P < 0.0001). In multivariate analyses, the following factors were significantly associated with an increased risk of relapse: ALL vs. AML M3 [relapse rate (RR) 2.29, P < 0.0001], AML non-M3 vs. AML M3 (RR 1.8, P < 0.0001), autograft vs. sibling transplant (RR 1.76, P < 0.0001), interval diagnosis to transplantation < 261 d (RR 1.45, P < 0.001) and other conditioning vs. total body irradiation (RR 1.16, P = 0.001). Transplant-related mortality was the same in the three groups at approximately 10% at 2 years. Five-year leukaemia-free survival was 42 +/- 1% in the autografts, 44 +/- 8% in the twins and 58 +/- 2% among the siblings (auto vs. sibs, P < 0.0001). The factors significant for relapse were also significant in multivariate analyses for leukaemia-free survival. In addition, children had a significantly better leukaemia-free survival than adults (RR 0.82, P < 0.0001). Recipients of bone marrow from HLA-identical siblings without GVHD had a lower risk of relapse and a better leukaemia-free survival than recipients of autografts. This may be as a result of a graft-vs.-leukaemia effect in the absence of GVHD.
在13年期间，欧洲血液和骨髓移植组（EBMT）共收到5200例自体移植、1039例无急性或慢性移植物抗宿主病（GVHD）的HLA全相合同胞移植以及67例双胞胎移植的报告。随访时间中位数为32个月。诊断为首次完全缓解的急性髓系白血病（AML，4521例）和急性淋巴细胞白血病（ALL，1785例）。自体移植组5年复发概率为51±1%，双胞胎移植组为45±8%，HLA全相合同胞移植组为34±2%（自体移植与同胞移植相比，P<0.0001）。多因素分析显示，以下因素与复发风险增加显著相关：ALL与AML M3相比[复发率（RR）2.29，P<0.0001]，AML非M3与AML M3相比（RR 1.8，P<0.0001），自体移植与同胞移植相比（RR 1.76，P<0.0001），诊断至移植间隔<261天（RR 1.45，P<0.001），以及其他预处理与全身照射相比（RR 1.16，P = 0.001）。三组的移植相关死亡率在2年时均约为10%。自体移植组5年无白血病生存率为42±1%，双胞胎移植组为44±8%，同胞移植组为58±2%（自体移植与同胞移植相比，P<0.0001）。对复发有显著影响的因素在无白血病生存的多因素分析中也具有显著性。此外，儿童的无白血病生存率显著高于成人（RR 0.82，P<0.0001）。接受无GVHD的HLA全相合同胞骨髓移植的受者比自体移植受者的复发风险更低，无白血病生存率更高。这可能是由于在无GVHD的情况下存在移植物抗白血病效应。
