Schattenberg A, De Witte T, Preijers F, Raemaekers J, Muus P, Van der Lely N, Boezeman J, Wessels J, Van Dijk B, Hoogenhout J
Division of Hematology, University Hospital Nijmegen, The Netherlands.
Blood. 1990 Mar 15;75(6):1356-63.
Eighty consecutive patients were transplanted with human leukocyte antigen (HLA)-identical sibling marrow for acute myelogenous leukemia (AML, N = 29), acute lymphoid leukemia (ALL, N = 23), or chronic myelogenous leukemia (CML, N = 28). Donor marrow was depleted of lymphocytes using counterflow centrifugation. Median age of the recipients was 31 years. Pretransplant conditioning consisted of cyclophosphamide and fractionated total body irradiation (TBI) with a low (4.1 +/- 0.3 cGy/min) or high (13.1 +/- 1.6 cGy/min) midline average dose rate. In 43 patients, cytosine-arabinoside or anthracyclines were added to the conditioning regimen. Immunoprophylaxis posttransplant consisted of methotrexate (MTX) alone, cyclosporine A (CsA) in combination with MTX, or CsA alone; two patients received no immunoprophylaxis at all. Graft failure occurred in 4 of 77 evaluable patients (5%). The probability of acute graft-versus-host disease (GVHD) greater than or equal to grade 2 at day 100 after transplantation was 15%. The projected 3-year estimate of extensive chronic GVHD was 12%. Only three patients died of cytomegalovirus-interstitial pneumonitis. The projected 3-year probability of relapse was 30% (95% confidence interval [CI], range 8% to 53%) in transplants for AML in first complete remission (CR1), 35% (95% CI, 1% to 69%) after transplantation for ALL in CR1, and 38% (95% CI, 2% to 74%) after transplantation for CML in first chronic phase (CP1). The projected 3-year probability of leukemia-free survival (LFS) was 56% (95% CI, 35% to 77%) after transplantation for AML-CR1, 42% (95% CI, 16% to 69%) in patients transplanted for ALL-CR1, and 49% (95% CI, 18% to 80%) after transplantation for CML-CP1. After transplantation for AML-CR1, ALL-CR1, or CML-CP1, the median follow-up time for leukemia-free survivors was 31+, 30+, and 21+ months, respectively. Probabilities of relapse, survival, and LFS in AML-CR1 and ALL-CR1 transplants were comparable with those reported in recipients of untreated grafts. In patients transplanted for CML-CP1, probability of relapse was higher and probability of LFS was lower than in recipients of untreated grafts. In transplants for leukemia in CR1 and CP1, preparative regimen and immunoprophylaxis posttransplant were not associated significantly with the probability of acute GVHD greater than or equal to grade 2, extensive chronic GVHD, relapse, survival, or LFS. In bone marrow transplantation for leukemia, counterflow centrifugation is a useful technique for the prevention of GVHD.(ABSTRACT TRUNCATED AT 400 WORDS)
80例连续患者接受了与人类白细胞抗原（HLA）匹配的同胞骨髓移植，用于治疗急性髓细胞白血病（AML，29例）、急性淋巴细胞白血病（ALL，23例）或慢性髓细胞白血病（CML，28例）。供体骨髓通过逆流离心法去除淋巴细胞。受者的中位年龄为31岁。移植前预处理包括环磷酰胺和分次全身照射（TBI），中线平均剂量率低（4.1±0.3 cGy/分钟）或高（13.1±1.6 cGy/分钟）。43例患者在预处理方案中加入了阿糖胞苷或蒽环类药物。移植后免疫预防包括单独使用甲氨蝶呤（MTX）、环孢素A（CsA）联合MTX或单独使用CsA；2例患者未接受任何免疫预防。77例可评估患者中有4例（5%）发生移植失败。移植后100天急性移植物抗宿主病（GVHD）≥2级的概率为15%。预计广泛性慢性GVHD的3年发生率为12%。仅3例患者死于巨细胞病毒间质性肺炎。首次完全缓解（CR1）的AML移植后预计3年复发概率为30%（95%置信区间[CI]，范围8%至53%），CR1的ALL移植后为35%（95%CI，1%至69%），首次慢性期（CP1）的CML移植后为38%（95%CI，2%至74%）。CR1的AML移植后预计3年无白血病生存（LFS）概率为56%（95%CI，35%至77%），CR1的ALL移植患者为42%（95%CI，16%至69%），CP1的CML移植后为49%（95%CI，18%至80%）。CR1的AML、CR1的ALL或CP1的CML移植后，无白血病生存者的中位随访时间分别为31+、30+和21+个月。CR1的AML和ALL移植的复发、生存和LFS概率与未处理移植物受者报道的概率相当。CP1的CML移植患者的复发概率高于未处理移植物受者，LFS概率低于未处理移植物受者。CR1和CP1白血病移植中，预处理方案和移植后免疫预防与≥2级急性GVHD、广泛性慢性GVHD、复发、生存或LFS概率无显著相关性。在白血病骨髓移植中，逆流离心法是预防GVHD的一种有用技术。（摘要截短至400字）
