McGlave P
Department of Medicine, University of Minnesota Medical Center, Minneapolis 54455.
Semin Hematol. 1990 Jul;27(3 Suppl 4):23-30.
The success of bone marrow transplantation in chronic myelogenous leukemia (CML) is strongly associated with the phase of the disease at the time of transplantation. For allogeneic transplants from siblings with identical human leukocyte antigens, the 3-year survival rate for recipients in chronic phase ranges from 55% to 70%, whereas survival falls to approximately 30% for recipients in accelerated phase and to 0% to 20% for patients receiving transplants during blast crisis. Detailed analysis of data pooled from 405 patients demonstrated that the 3-year probability of relapse was 48% for recipients of T-cell-depleted bone marrow, but only 9% for recipients of non-T-cell-depleted bone marrow (relative risk, 5.4; P less than .0001). Regardless of transplant T-cell status, however, patients who developed chronic graft-versus-host disease (GVHD) were less likely to relapse at 4 years when compared with recipients without chronic GVHD (6% v 24%; relative risk, 3.1; P less than .01). Survival was correlated with severity of acute GVHD and age. Allogeneic bone marrow transplantation from unrelated donors can be useful in expanding the patient population eligible for transplantation. A study of recipients of transplants from unrelated donors showed a 3-year projected survival of 55% for chronic phase patients, and 22% for patients with advanced disease. However, a high rate of graft failure (10%) and grade II to IV acute GVHD can be expected. Preliminary data suggest that ex vivo treatment of autologous bone marrow with interferon can effect complete or partial Philadelphia (Ph) chromosome negative bone marrow mosaicism, although appearance of Ph chromosome negative metaphases may not be persistent. Thus, interferon treatment of autologous bone marrow may play a more significant role in the treatment of CML.
慢性粒细胞白血病（CML）患者进行骨髓移植的成功与否与移植时疾病的阶段密切相关。对于接受来自具有相同人类白细胞抗原的同胞的异基因移植的患者，慢性期受者的3年生存率为55%至70%，而加速期受者的生存率降至约30%，处于急变期接受移植的患者生存率为0%至20%。对405例患者汇总数据的详细分析表明，接受去除T细胞骨髓移植的患者3年复发概率为48%，而接受未去除T细胞骨髓移植的患者仅为9%（相对风险为5.4；P<0.0001）。然而，无论移植时T细胞状态如何，发生慢性移植物抗宿主病（GVHD）的患者与未发生慢性GVHD的受者相比，4年时复发的可能性较小（6%对24%；相对风险为3.1；P<0.01）。生存率与急性GVHD的严重程度和年龄相关。来自无关供者的异基因骨髓移植对于扩大适合移植的患者群体可能有用。一项对接受来自无关供者移植的患者的研究表明，慢性期患者的预计3年生存率为55%，晚期疾病患者为22%。然而，可以预期移植失败率较高（10%）以及发生II至IV级急性GVHD。初步数据表明，用干扰素对自体骨髓进行体外处理可实现完全或部分费城（Ph）染色体阴性的骨髓镶嵌现象，尽管Ph染色体阴性中期的出现可能并不持久。因此，干扰素治疗自体骨髓可能在CML的治疗中发挥更重要的作用。
