Linker C A, Damon L E, Ries C A, Navarro W A, Case D, Wolf J L
University of California, San Francisco, CA, USA.
Bone Marrow Transplant. 2002 Feb;29(4):297-301. doi: 10.1038/sj.bmt.1703361.
We studied the efficacy of a two-step approach to autologous stem cell transplantation for patients with advanced acute myeloid leukemia. Step 1 consisted of consolidation chemotherapy using cytarabine 2000 mg/m(2) twice daily for 4 days plus etoposide 40 mg/kg by continuous infusion over the same 4 days. Peripheral blood stem cells were collected under granulocyte colony-stimulating factor (G-CSF) stimulation during recovery from this chemotherapy. Step 2, autologous stem cell transplantation, utilized the preparative regimen of oral busulfan 16 mg/kg followed by etoposide 60 mg/kg i.v. During step 1, there were no treatment-related deaths among 28 patients, but two patients did not proceed to transplantation because of failure of mobilization. A median CD34+ dose (x10(6)/kg) of 13.6 was collected. Of 26 patients undergoing autologous transplant, there was one treatment-related death and 12 relapses. With a median follow-up of 5.4 years, 5 year event-free survival (EFS) of all patients entered is 54%. The most important prognostic factor was cytogenetic changes. All seven patients with t(15,17) remained in long-term remission whereas EFS for other patients was 38%. We conclude that this two-step approach to autologous transplantation produces excellent stem cell yields, allows a high percentage of patients to receive the intended therapy, and provides effective treatment.
我们研究了两步法自体干细胞移植治疗晚期急性髓系白血病患者的疗效。第一步包括巩固化疗，使用阿糖胞苷2000mg/m²，每日两次，共4天，加依托泊苷40mg/kg，在相同的4天内持续静脉输注。在该化疗恢复期间，于粒细胞集落刺激因子（G-CSF）刺激下采集外周血干细胞。第二步，自体干细胞移植，采用口服白消安16mg/kg，随后静脉注射依托泊苷60mg/kg的预处理方案。在第一步中，28例患者中无治疗相关死亡，但有2例患者因动员失败未进行移植。采集的CD34⁺细胞中位剂量（×10⁶/kg）为13.6。在26例接受自体移植的患者中，有1例治疗相关死亡和12例复发。中位随访5.4年，所有入组患者的5年无事件生存率（EFS）为54%。最重要的预后因素是细胞遗传学改变。所有7例t(15;17)患者均长期缓解，而其他患者的EFS为38%。我们得出结论，这种两步法自体移植可产生优异的干细胞产量，使高比例患者能够接受预期治疗，并提供有效的治疗。
