McMillan A K, Goldstone A H, Linch D C, Gribben J G, Patterson K G, Richards J D, Franklin I, Boughton B J, Milligan D W, Leyland M M
University College and Middlesex Schools of Medicine, Leicester, UK.
Blood. 1990 Aug 1;76(3):480-8.
For younger patients with acute myeloid leukemia (AML), an allogeneic transplant from a matched sibling may afford the best chance of cure. In patients who are older or without a matched sibling donor, dose intensification can be achieved with an autologous bone marrow transplant (ABMT). We report here the results of a high-dose chemotherapy regime with nonpurged ABMT in 82 adult patients in first remission of AML with a median follow-up of 31 months. The median age was 40 years (range 16 to 57 years). The median interval between remission and ABMT was 5 months (range 1 to 12 months). Twenty-eight of these patients received a second course of the same high-dose chemotherapy and ABMT. The procedure related mortality rate was 6%. The projected leukemia-free survival (LFS) at 5 years is 48% for all 82 patients and 50% for the 76 patients with no known preceding myelodysplastic syndrome. For those patients with primary AML who received a double ABMT the projected LFS is 67%. The interval between remission and ABMT did not predict for either relapse or LFS. ABMT using a multidrug chemotherapy protocol is less toxic than allogeneic BMT yet results in a similar LFS.
对于年轻的急性髓系白血病（AML）患者，来自匹配同胞的异基因移植可能提供最佳的治愈机会。对于年龄较大或没有匹配同胞供体的患者，可以通过自体骨髓移植（ABMT）实现剂量强化。我们在此报告了82例处于AML首次缓解期的成年患者接受非净化ABMT的大剂量化疗方案的结果，中位随访时间为31个月。中位年龄为40岁（范围16至57岁）。缓解与ABMT之间的中位间隔为5个月（范围1至12个月）。其中28例患者接受了相同大剂量化疗和ABMT的第二个疗程。手术相关死亡率为6%。所有82例患者5年的预计无白血病生存率（LFS）为48%，76例无已知既往骨髓增生异常综合征的患者为50%。对于接受双重ABMT的原发性AML患者，预计LFS为67%。缓解与ABMT之间的间隔既不能预测复发也不能预测LFS。使用多药化疗方案的ABMT毒性低于异基因BMT，但LFS相似。
