Linker C A
Division of Hematology/Oncology, University of California, San Francisco, USA.
Bone Marrow Transplant. 2003 May;31(9):731-8. doi: 10.1038/sj.bmt.1704020.
Autologous bone marrow transplant (ABMT) and stem cell transplantation (ASCT) are important treatment modalities for acute myeloid leukemia (AML). The role of ASCT in first remission patients remains controversial. Phase II and phase III studies demonstrate that patients with favorable-risk cytogenetics benefit from ASCT, with reduction in relapse and improvement in leukemia-free survival (LFS). Patients with poor-risk cytogenetics do not appear to benefit significantly from ASCT and should preferentially be treated with allogeneic transplant. The role of ASCT for patients with intermediate risk disease is uncertain. It appears that ASCT in first remission will improve disease-free survival compared to standard chemotherapy. Sufficient patients who relapse after chemotherapy treatment can be salvaged with ASCT in second remission such that the beneficial effect on overall survival is blunted. ASCT produces equivalent results to ABMT but with reduced morbidity. The collection of stem cells during recovery from intensive dose consolidation therapy appears to be an attractive strategy that can increase the percentage of patients who are able to receive their intended transplant. Consolidation therapy prior to stem cell collection and transplant has been shown to decrease the relapse rate and improve outcomes, but the optimal nature of this consolidation therapy is unknown. For patients with AML in second remission, ABMT/ASCT offers a substantial salvage rate, and is particularly effective for patients with acute promyelocytic leukemia.
自体骨髓移植（ABMT）和干细胞移植（ASCT）是急性髓系白血病（AML）的重要治疗方式。ASCT在首次缓解期患者中的作用仍存在争议。II期和III期研究表明，细胞遗传学风险良好的患者可从ASCT中获益，复发率降低，无白血病生存期（LFS）得到改善。细胞遗传学风险不良的患者似乎无法从ASCT中显著获益，应优先接受异基因移植。ASCT对中危疾病患者的作用尚不确定。与标准化疗相比，首次缓解期进行ASCT似乎可改善无病生存期。化疗后复发的足够数量患者可在第二次缓解期通过ASCT挽救，从而使对总生存期的有益作用减弱。ASCT产生的结果与ABMT相当，但发病率更低。在强化剂量巩固治疗恢复期间采集干细胞似乎是一种有吸引力的策略，可增加能够接受预期移植的患者比例。干细胞采集和移植前的巩固治疗已被证明可降低复发率并改善预后，但这种巩固治疗的最佳性质尚不清楚。对于第二次缓解期的AML患者，ABMT/ASCT具有较高的挽救率，对急性早幼粒细胞白血病患者尤其有效。
