Wingard J R, Piantadosi S, Santos G W, Saral R, Vriesendorp H M, Yeager A M, Burns W H, Ambinder R F, Braine H G, Elfenbein G
Bone Marrow Transplantation Program, Johns Hopkins Oncology Center, Baltimore, MD 21205.
J Clin Oncol. 1990 May;8(5):820-30. doi: 10.1200/JCO.1990.8.5.820.
Seventy-four consecutive patients with high-risk acute lymphoblastic leukemia (ALL) were given cyclophosphamide (CY; 50 mg/kg on each of 4 days) plus total body irradiation (TBI; 300 rad on each of 4 days) followed by a human leukocyte antigen (HLA)-identical allogeneic bone marrow transplant (BMT). Eighteen patients in first complete remission (CR1), 36 in CR2, 16 in CR3, and four in CR4 were transplanted. Patients in CR1 were transplanted 1 to 8 months (median, 3 months) after attaining CR. All 18 patients in CR1 had one or more poor risk factors: age more than 18 (N = 17), initial leukocyte count greater than or equal to 20,000 (N = 11), Ph 1 chromosome (N = 2), delay in attaining CR more than 6 weeks (N = 8), or extramedullary disease (N = 1). Of those transplanted in CR2, 72% had relapsed on therapy. The 5-year event-free survival (EFS) rates for patients transplanted in CR1, CR2, and CR3 are 42%, 43%, and 25%, respectively, at median follow-up times of 57, 54, and 72 months, respectively. Children aged less than 18 years transplanted in CR2 have a 5-year EFS rate of 54%. All CR4 patients died early after transplant. The actuarial probability of relapse is 20%, 26%, and 48% for those transplanted in CR1, CR2, and CR3, respectively. Although there was substantial transplant-associated mortality, it decreased over the decade of the study (P = .01). This study indicates that BMT offers an attractive alternative to postremission chemotherapy in patients in CR1 with poor prognostic factors and in patients in second remission.
74例高危急性淋巴细胞白血病（ALL）患者接受了环磷酰胺（CY；4天内每天50mg/kg）加全身照射（TBI；4天内每天300拉德），随后进行人类白细胞抗原（HLA）匹配的异基因骨髓移植（BMT）。其中18例处于首次完全缓解（CR1），36例处于CR2，16例处于CR3，4例处于CR4时接受移植。CR1患者在达到CR后1至8个月（中位数为3个月）接受移植。所有18例CR1患者均有一个或多个不良危险因素：年龄大于18岁（n = 17）、初始白细胞计数大于或等于20,000（n = 11）、Ph 1染色体（n = 2）、达到CR延迟超过6周（n = 8）或髓外疾病（n = 1）。在CR2期接受移植的患者中，72%在治疗期间复发。在CR1、CR2和CR3期接受移植的患者，5年无事件生存率（EFS）分别为42%、43%和25%，中位随访时间分别为57、54和72个月。在CR2期接受移植的年龄小于18岁的儿童5年EFS率为54%。所有CR4患者在移植后早期死亡。CR1、CR2和CR3期接受移植的患者复发的精算概率分别为20%、26%和48%。虽然存在大量与移植相关的死亡率，但在研究的十年间有所下降（P = 0.01）。这项研究表明，对于具有不良预后因素的CR1患者和二次缓解患者，BMT为缓解后化疗提供了有吸引力的替代方案。
