Russell James A, Savoie Mary Lynn, Balogh Alexander, Turner A Robert, Larratt Loree, Chaudhry M Ahsan, Storek Jan, Bahlis Nizar J, Brown Christopher B, Quinlan Diana, Geddes Michelle, Stewart Douglas A
Alberta Blood and Bone Marrow Transplant Program, Department of Oncology, Foothills Hospital, Alberta, Canada.
Biol Blood Marrow Transplant. 2007 Jul;13(7):814-21. doi: 10.1016/j.bbmt.2007.03.003. Epub 2007 Apr 23.
A myeloablative conditioning regimen incorporating daily intravenous busulfan, fludarabine, and 400 cGy total-body irradiation was given before allogeneic stem cell transplantation (SCT) to 64 adults with acute leukemia in first and second remission. Graft-versus-host disease (GVHD) prophylaxis included methotrexate, cyclosporine A, and rabbit antithymocyte globulin (Thymoglobulin). For 31 matched related (MRD) and 33 alternate donor (AD) SCT the incidence of acute GVHD grade II-IV was 11% +/- 6% versus 35% +/- 9% (P = .047), acute GVHD grade III-IV was 0% versus 10% +/- 6% (P = .09), and chronic GVHD was 40% +/- 9% versus 66% +/- 9% (P = NS), respectively. Overall transplant-related mortality (TRM) was 3% +/- 2%. Projected disease-free (DFS) and overall survival (OS) at 3 years for acute myelogenous leukemia (AML) (n = 36) are the same at 83% +/- 6%, and for acute lymphoblastic leukemia (ALL) (n = 28) are 65% +/- 10% and 78% +/- 8%, respectively. For MRD SCT DFS is 77% +/- 9%, OS 87% +/- 6%, for AD SCT the respective figures are 71% +/- 8% and 74% +/- 8%. OS and DFS in patients without and with high-risk features are 100% versus 71% +/- 7% (P = .007) and 88% +/- 8% versus 68% +/- 7% (P = .04), respectively. This combination appears relatively well tolerated, gives equivalent final outcomes from MRD and AD, and may be a reasonable alternative to conventional myeloablative regimens.
在64例处于首次和第二次缓解期的成年急性白血病患者接受异基因干细胞移植（SCT）之前，给予包含每日静脉注射白消安、氟达拉滨以及400 cGy全身照射的清髓性预处理方案。移植物抗宿主病（GVHD）预防措施包括甲氨蝶呤、环孢素A和兔抗胸腺细胞球蛋白（即胸腺球蛋白）。对于31例匹配相关供者（MRD）和33例替代供者（AD）的SCT，II-IV级急性GVHD的发生率分别为11%±6%和35%±9%（P = 0.047），III-IV级急性GVHD的发生率分别为0%和10%±6%（P = 0.09），慢性GVHD的发生率分别为40%±9%和66%±9%（P = 无显著性差异）。总体移植相关死亡率（TRM）为3%±2%。急性髓细胞白血病（AML）（n = 36）患者3年时预计的无病生存率（DFS）和总生存率（OS）相同，均为83%±6%，急性淋巴细胞白血病（ALL）（n = 28）患者的3年DFS和OS分别为65%±10%和78%±8%。对于MRD SCT，DFS为77%±9%，OS为87%±6%；对于AD SCT，相应数字分别为71%±8%和74%±8%。无高危特征和有高危特征患者的OS和DFS分别为100%对71%±7%（P = 0.007）以及88%±8%对68%±7%（P = 0.04）。这种联合方案似乎耐受性相对良好，MRD和AD的最终结局相当，可能是传统清髓性方案的合理替代方案。
