Willemze R, Suciu S, Mandelli F, de Witte T, Amador S
Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands.
Ann Hematol. 2004;83 Suppl 1:S134. doi: 10.1007/s00277-004-0850-2.
Using the data of the patients in complete remission (CR) up to the age of 45 years included in the EORTC-LG/GIMEMA AML-10 trial we investigated the value of the strategy to perform either an autologous (auto-SCT) or an allogeneic (allo-SCT) stem cell transplantation on an intention to treat basis. Between 1993 and 1999, out of 1198 pts, 822 achieved CR. 734 pts, constituting the study group, received an intensieve consolidation course: 293 had a sibling donor and 441 had not. Allo-SCT and auto-SCT was performed in 68.9% and 55.8%, respectively. Cytogenetics was successfully performed in 446 pts. Risk groups were: good (t(8;21), inv(16)), intermediate (NN or -Y only), bad/very bad (all others). Median follow-up was 4 years. The 4-year disease-free survival (DFS) rate of patients with a donor vs of those without a donor was 52.2% vs 42.2%, p = 0.044; the relapse incidence was 30.4% vs 52.5%, death in first complete remission was 17.4% vs 5.3%, and the survival rate was 58.3% vs 50.8% (p = 0.18). The DFS rates in pts with and without a sibling donor were similar in pts with good or intermediate risk cytogenetics, but 43.4% and 18.4%, respectively, in pts with bad or very bad risk cytogenetics. In younger patients (15-35 yrs), the difference was more pronounced. The strategy to perform an allo-SCT in patients where a family donor was available led to better overall results than to perform an auto-SCT, especially for younger patients or those with bad or very bad risk cytogenetics.
利用欧洲癌症研究与治疗组织-淋巴瘤研究组/意大利多中心成人白血病研究组急性髓系白血病-10试验中纳入的45岁及以下完全缓解（CR）患者的数据，我们在意向性治疗的基础上研究了进行自体（auto-SCT）或异基因（allo-SCT）干细胞移植策略的价值。1993年至1999年期间，在1198例患者中，822例实现了CR。734例患者组成研究组，接受了强化巩固疗程：293例有同胞供者，441例没有。allo-SCT和auto-SCT的实施率分别为68.9%和55.8%。446例患者成功进行了细胞遗传学检测。风险组分为：良好（t(8;21)、inv(16)）、中等（仅NN或-Y）、不良/非常不良（其他所有情况）。中位随访时间为4年。有供者患者与无供者患者的4年无病生存率（DFS）分别为52.2%和42.2%，p = 0.044；复发率分别为30.4%和52.5%，首次完全缓解期死亡率分别为17.4%和5.3%，生存率分别为58.3%和50.8%（p = 0.18）。细胞遗传学风险良好或中等的患者中，有和没有同胞供者的患者DFS率相似，但细胞遗传学风险不良或非常不良的患者中，这一比例分别为43.4%和18.4%。在年轻患者（15 - 35岁）中，差异更为明显。对于有家族供者的患者，进行allo-SCT的策略比进行auto-SCT能带来更好的总体结果，特别是对于年轻患者或细胞遗传学风险不良或非常不良的患者。
