Linker C A, Owzar K, Powell B, Hurd D, Damon L E, Archer L E, Larson R A
Department of Medicine, University of California, San Francisco, CA 94143, USA.
Bone Marrow Transplant. 2009 Sep;44(6):353-9. doi: 10.1038/bmt.2009.36. Epub 2009 Mar 16.
We studied the feasibility and efficacy of a two-step approach to Auto-SCT for patients with AML in second remission. Step 1 consisted of consolidation chemotherapy using cytarabine 2000 mg/m(2) i.v. every 12 h for 4 days plus etoposide 40 mg/kg total dose by continuous i.v. infusion over the same 4 days. PBSC were collected after G-CSF stimulation during recovery from this chemotherapy. Step 2, auto-SCT, used a preparative regimen of oral BU 16 mg/kg over 4 days followed by etoposide 60 mg/kg i.v. Of the 50 patients entered on Step 1, two died from treatment complications, and seven failed to proceed to transplantation. A median CD34+ cell dose of 5.9 x 10(6)/kg was collected in a median of three collections. With a median follow-up of 8.2 years, 5-year disease-free survival (DFS) is 28%. The most important prognostic factor was cytogenetics, with acute promyelocytic leukemia (APL) patients having a 5-year DFS of 67% compared with 16% for others. We conclude that this two-step approach to autologous transplantation produces good CD34+ mobilization and that this approach has cured some patients. Results in patients with APL are especially promising.
我们研究了两步法自体造血干细胞移植（Auto-SCT）用于急性髓系白血病（AML）第二次缓解期患者的可行性和疗效。第一步包括巩固化疗，使用阿糖胞苷2000mg/m²静脉注射，每12小时一次，共4天，加依托泊苷总剂量40mg/kg，在相同的4天内持续静脉输注。在此次化疗恢复期间，经粒细胞集落刺激因子（G-CSF）刺激后采集外周血干细胞（PBSC）。第二步，自体造血干细胞移植，采用预处理方案，口服白消安（BU）16mg/kg，持续4天，随后静脉注射依托泊苷60mg/kg。在进入第一步的50例患者中，2例死于治疗并发症，7例未能进行移植。中位采集次数为3次，中位CD34⁺细胞剂量为5.9×10⁶/kg。中位随访8.2年，5年无病生存率（DFS）为28%。最重要的预后因素是细胞遗传学，急性早幼粒细胞白血病（APL）患者的5年DFS为67%，而其他患者为16%。我们得出结论，这种两步法自体移植能产生良好的CD34⁺细胞动员效果，且该方法已治愈了部分患者。APL患者的结果尤其令人鼓舞。
