急性髓系白血病与自体干细胞移植的地位

Acute myeloid leukemia and the position of autologous stem cell transplantation.

作者信息

Breems Dimitri A, Löwenberg Bob

机构信息

Department of Hematology, Hospital Network Antwerp, General Hospital Stuivenberg, Antwerp, Belgium, and Erasmus University Medical Center, Rotterdam, The Netherlands.

出版信息

Semin Hematol. 2007 Oct;44(4):259-66. doi: 10.1053/j.seminhematol.2007.08.002.

Abstract

Most adult patients with acute myeloid leukemia (AML) who reach a complete remission (CR) after induction chemotherapy will relapse if they do not receive further therapy. Autologous stem cell transplantation (SCT) represents one of the options of postremission therapy in AML. Here we discuss the therapeutic impact of consolidation treatment with autologous SCT that has been studied extensively. Meta-analyses of published randomized trials using bone marrow as the source of stem cells show a modest improvement of disease-free survival as compared to nonmyeloablative chemotherapy. However, there is no apparent improvement of overall survival, probably due to the slightly increased mortality associated with autologous bone marrow transplantation (BMT). Subsequently, the value of autologous SCT in different prognostic subsets of AML is discussed. Autologous mobilized peripheral blood stem cell (PBSC) transplantation offers a much faster hematopoietic recovery and is associated with reduced morbidity and treatment-related mortality. To fully appreciate the role of autologous PBSC transplantation, the results of a recently closed randomized trial must be awaited.

摘要

大多数急性髓系白血病(AML)成年患者在诱导化疗后达到完全缓解(CR),若不接受进一步治疗将会复发。自体干细胞移植(SCT)是AML缓解后治疗的选择之一。在此,我们讨论已被广泛研究的自体SCT巩固治疗的疗效。对以骨髓作为干细胞来源的已发表随机试验进行的荟萃分析表明,与非清髓性化疗相比,无病生存期有适度改善。然而,总生存期并无明显改善,这可能是由于自体骨髓移植(BMT)相关死亡率略有增加所致。随后,讨论了自体SCT在AML不同预后亚组中的价值。自体外周血干细胞(PBSC)移植造血恢复更快,且发病率和治疗相关死亡率降低。要全面了解自体外周血干细胞移植的作用,必须等待最近结束的一项随机试验的结果。

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