Ringdén O, Aschan J, Boström L, Dahllöf G, Tollemar J, Paulin T, Gahrton G, Groth C G, Klaesson S, Lindquist R
Department of Clinical Immunology, Karolinska Institute, Huddinge Hospital, Stockholm, Sweden.
Clin Transpl. 1990:175-87.
At Huddinge Hospital 275 patients underwent allogeneic bone marrow transplantation. Among children in first remission of acute leukemia or chronic phase CML (early leukemia), with HLA-identical marrow the 8-year leukemia-free survival was 77%. This was better than 38% in children undergoing transplantation in second to fourth remission (p less than 0.0009). In adults with early leukemia, the 8-year leukemia-free survival was 47% compared to 21% for intermediate-risk adults (p = 0.007). Among 25 patients with severe aplastic anemia receiving marrow from HLA-identical siblings, the actuarial 10-year survival was 78%. In 14 patients with various metabolic disorders, of whom half received marrow from HLA-mismatched donors, the actuarial 7-year survival was 71%. Forty-three patients were given marrow from HLA-mismatched donors and had an increased incidence of acute graft-versus-host disease (GvHD) and death due to GvHD compared to recipients of HLA-identical bone marrow. The major causes of death among our patients were relapse of leukemia, death due to GvHD, cytomegalovirus (CMV) pneumonitis, bacterial infection and invasive fungal infections. By preventing GvHD with T-cell depletion or methotrexate (MTX) combined with cyclosporine (CsA) acute GvHD decreased, but the incidence of relapse increased compared to patients treated with MTX or CsA alone. This resulted in improved survival in patients older than 30 years, but a nonsignificant decrease in leukemia-free survival in younger patients. There was an association between herpes virus immunity in the recipient and GvHD. CMV pneumonitis increased following GvHD and decreased in patients treated with MTX combined with CsA. Invasive fungal infections may be treated or prevented using amphotericin B encapsulated in liposomes with few side effects.
在胡丁厄医院，275例患者接受了异基因骨髓移植。在急性白血病首次缓解期或慢性粒细胞白血病慢性期（早期白血病）的儿童中，使用 HLA 相同的骨髓，8年无白血病生存率为77%。这优于处于第二次至第四次缓解期接受移植的儿童的38%（p<0.0009）。在早期白血病的成人患者中，8年无白血病生存率为47%，而中度风险成人患者为21%（p = 0.007）。在25例接受 HLA 相同同胞骨髓的严重再生障碍性贫血患者中，精算10年生存率为78%。在14例患有各种代谢紊乱的患者中，其中一半接受了 HLA 不匹配供体的骨髓，精算7年生存率为71%。43例患者接受了 HLA 不匹配供体的骨髓，与接受 HLA 相同骨髓的受者相比，急性移植物抗宿主病（GvHD）的发生率和因 GvHD 导致的死亡率增加。我们患者的主要死亡原因是白血病复发、GvHD 导致的死亡、巨细胞病毒（CMV）肺炎、细菌感染和侵袭性真菌感染。通过用 T 细胞清除或甲氨蝶呤（MTX）联合环孢素（CsA）预防 GvHD，急性 GvHD 减少，但与单独使用 MTX 或 CsA 治疗的患者相比，复发率增加。这导致30岁以上患者的生存率提高，但年轻患者的无白血病生存率无显著下降。受者的疱疹病毒免疫与 GvHD 之间存在关联。GvHD 后 CMV 肺炎增加，而 MTX 联合 CsA 治疗的患者中 CMV 肺炎减少。侵袭性真菌感染可用副作用少的脂质体包裹两性霉素 B 进行治疗或预防。
