Klingebiel T, Reinhardt D, Bader P
Klinik für Kinder- und Jugendmedizin III, Johann Wolfgang Goethe University, Frankfurt/Main, Germany.
Bone Marrow Transplant. 2008 Oct;42 Suppl 2:S7-9. doi: 10.1038/bmt.2008.276.
This short review focuses on the role of hematopoietic SCT (HSCT) in childhood AML. In first CR (CR1), some studies demonstrate superiority of allogeneic HSCT with HLA identical sibling donors over the continuation of chemotherapy and others did not. The studies differ in regard to the included risk categories of patients and the outcome niveau of the chemotherapy arm. The BFM98 study found no benefit in having a donor, in particular in terms of overall survival. Autologous HSCT in CR1 is not superior in any of the reviewed trials over the continuation of chemotherapy. In second CR, evidence for the function of allogeneic HSCT is small. However, published data and evidence-based reports recommend an unrelated or related transplantation in the situation of a renewed remission. Data on haploidentical HSCT and on cord blood HSCT are still lacking in the case of AML. Combined studies of larger study groups are warranted to broaden the data basis for rational decision.
这篇简短的综述聚焦于造血干细胞移植（HSCT）在儿童急性髓系白血病（AML）中的作用。在首次完全缓解（CR1）时，一些研究表明，与继续化疗相比，采用人类白细胞抗原（HLA）相合的同胞供者进行异基因HSCT具有优势，而其他研究则未发现此优势。这些研究在纳入的患者风险类别以及化疗组的结局水平方面存在差异。德国柏林-法兰克福-明斯特协作组（BFM）98研究发现，拥有供者并无益处，尤其是在总生存方面。在所有综述的试验中，CR1期自体HSCT并不优于继续化疗。在第二次完全缓解（CR2）时，异基因HSCT作用的证据较少。然而，已发表的数据和循证报告建议，在再次缓解的情况下进行无关或相关供者移植。对于AML，单倍体相合HSCT和脐血HSCT的数据仍然缺乏。有必要开展更大研究组的联合研究，以拓宽数据基础，为合理决策提供依据。
