Appelbaum Frederick R
Fred Hutchinson Cancer Research Center and University of Washington School of Medicine, Seattle, WA 98109-1024, USA.
Best Pract Res Clin Haematol. 2007 Mar;20(1):67-75. doi: 10.1016/j.beha.2006.10.007.
Hematopoietic cell transplantation from a histocompatible sibling is generally recommended for patients with acute myeloid leukemia in first remission with intermediate or high risk disease. Two-thirds of patients lack a matched sibling raising the question of the utility of matched unrelated transplantation for such patients. Retrospective studies from single institutions and registry data report 44-50% disease-free survival at 5-years following ablative unrelated donor transplantation for adults. The German AML 01/99 is the only prospective study evaluating the utility of matched related and unrelated transplantation for AML patients in first remission with high risk disease and reported 4-year survival of 68% with matched related transplants, 56% with matched unrelated transplants and 23% with autografting. Thus, results suggest that for patients with AML in first remission with high risk features (as determined by cytogenetics or >5% blasts on day 15 of induction) who lack matched siblings, unrelated donor transplantation should be considered. Current challenges are to improve our ability to identify those patients most likely to benefit from early transplantation, to better select donors, and to develop transplant preparative regimens that are safer and more effective.
对于处于首次缓解期且患有中高危疾病的急性髓系白血病患者，通常建议进行来自组织相容性同胞的造血细胞移植。三分之二的患者没有匹配的同胞，这就引发了匹配的无关供体移植对此类患者的效用问题。来自单一机构的回顾性研究和登记数据显示，成人接受清髓性无关供体移植后5年的无病生存率为44%-50%。德国AML 01/99研究是唯一一项评估匹配的相关和无关供体移植对处于首次缓解期且患有高危疾病的急性髓系白血病患者的效用的前瞻性研究，该研究报告称，匹配的相关供体移植的4年生存率为68%，匹配的无关供体移植为56%，自体移植为23%。因此，结果表明，对于处于首次缓解期且具有高危特征（由细胞遗传学或诱导第15天原始细胞>5%确定）且没有匹配同胞的急性髓系白血病患者，应考虑无关供体移植。当前的挑战是提高我们识别那些最有可能从早期移植中获益的患者的能力，更好地选择供体，并开发更安全、更有效的移植预处理方案。
