Blaise D, Gaspard M H, Stoppa A M, Michel G, Gastaut J A, Lepeu G, Tubiana N, Blanc A P, Rossi J F, Novakovitch G
INSERM Unit No. 119, Institute Paoli-Calmettes, Marseille, France.
Bone Marrow Transplant. 1990 Jan;5(1):7-12.
Forty-seven patients with high risk acute lymphoblastic leukemia (ALL) received an allogeneic (allo) or autologous (auto) bone marrow transplant (BMT). Patients in both groups were comparable in terms of age, initial presentation of ALL and induction chemotherapy. Allo patients were transplanted earlier (median 3 months after CR) than auto patients (median 6.5 months after CR). Auto patients received more consolidation chemotherapy before BMT. All patients received total body irradiation 2.2 Gy/day x 5 days after cyclophosphamide 60 mg/kg x 2 (18 allo and five auto) or melphalan 140 mg/m2 (seven allo and 17 auto). Prevention of graft-versus-host disease (GVHD) was by conventional immunosuppression in 17 patients and T cell depletion in eight. Seven patients (28%) developed moderate to severe acute GVHD. Auto marrow was treated in vitro in each case. Seven patients died in CR from BMT complications (five allo and two auto). The probability of relapse was 9% for patients receiving allo BMT and 52% for patients receiving auto BMT (p less than 0.01). The disease-free survival was 71% for allo BMT and 40% for auto BMT (p = NS). Early BMT is an effective form of consolidation for high risk patients with ALL in first CR. An allogeneic anti-leukemia effect was demonstrated in this study.
47例高危急性淋巴细胞白血病（ALL）患者接受了异基因（allo）或自体（auto）骨髓移植（BMT）。两组患者在年龄、ALL的初始表现和诱导化疗方面具有可比性。异基因移植患者比自体移植患者更早接受移植（CR后中位时间3个月 vs 6.5个月）。自体移植患者在BMT前接受了更多的巩固化疗。所有患者在环磷酰胺60mg/kg×2（18例异基因和5例自体）或美法仑140mg/m²（7例异基因和17例自体）后，接受了每天2.2Gy×5天的全身照射。17例患者通过传统免疫抑制预防移植物抗宿主病（GVHD），8例患者通过T细胞清除预防。7例患者（28%）发生了中度至重度急性GVHD。每例患者的自体骨髓均在体外进行处理。7例患者在CR期死于BMT并发症（5例异基因和2例自体）。接受异基因BMT的患者复发概率为9%，接受自体BMT的患者复发概率为52%（p<0.01）。异基因BMT的无病生存率为71%，自体BMT为40%（p=无显著性差异）。早期BMT是首次CR期高危ALL患者有效的巩固治疗形式。本研究证实了异基因抗白血病效应。
