Johnson F L
Section of Pediatric Hematology/Oncology, University of Chicago Medical Center, Illinois.
Hematol Oncol Clin North Am. 1990 Oct;4(5):997-1008.
Allogeneic bone marrow transplantation is the only therapy introduced in the past 2 decades that has offered a better prognosis for children with ALL who have suffered a marrow relapse within 18 months of starting therapy. Currently, 40 to 50% of such patients are obtaining long remissions and are potentially cured by marrow transplantation. This therapy's effectiveness, however, is diminished by the problems of acute and chronic graft-versus-host disease, infection, and relapse. Further impact of marrow transplantation in the treatment of ALL awaits (1) more effective antileukemic preparative regimens or post-transplant antileukemic strategies, (2) less toxic preparative regimens to decrease the incidence of early and late effects, (3) more effective means of preventing and treating graft-versus-host disease, (4) the ability to safely perform mismatched marrow transplantation, and (5) more effective means of purging leukemic cells from remission bone marrow to expand the role of autologous marrow transplantation.
异基因骨髓移植是过去20年中引入的唯一一种能为在治疗开始后18个月内发生骨髓复发的急性淋巴细胞白血病（ALL）患儿带来更好预后的疗法。目前，这类患者中有40%至50%正在获得长期缓解，并且有可能通过骨髓移植治愈。然而，急性和慢性移植物抗宿主病、感染及复发等问题削弱了这种疗法的有效性。骨髓移植在ALL治疗中的进一步影响尚有待于：（1）更有效的抗白血病预处理方案或移植后抗白血病策略；（2）毒性更小的预处理方案以降低早期和晚期效应的发生率；（3）预防和治疗移植物抗宿主病的更有效方法；（4）安全进行不匹配骨髓移植的能力；（5）从缓解期骨髓中清除白血病细胞的更有效方法，以扩大自体骨髓移植的作用。
