Lancet. 1989 May 20;1(8647):1119-22.
It is not known whether chemotherapy or bone-marrow transplantation is the more effective treatment for acute myelogenous leukaemia (AML) in first remission. Consequently, some centres recommend transplants only for patients for whom a poor response to chemotherapy is predicted. To assess how reasonable this strategy is, data from 704 recipients of HLA-identical sibling transplants for AML in first remission were analysed. 5-year leukaemia-free survival (LFS) was 48% (95% confidence interval 43-53%); leukaemia relapse rate was 20% (16-24%). Improved LFS was associated with younger age and lower white blood cell count at diagnosis. These prognostic variables are similar to those reported to affect outcome after chemotherapy. These findings suggest that a strategy of treatment assignment based on risk factor analysis is unlikely to resolve the controversy of transplant versus chemotherapy for AML in first remission.
目前尚不清楚化疗或骨髓移植对首次缓解的急性髓性白血病（AML）哪种治疗方法更有效。因此，一些中心仅建议对预计对化疗反应不佳的患者进行移植。为了评估该策略的合理性，分析了704例接受HLA相同同胞移植的首次缓解AML患者的数据。5年无白血病生存率（LFS）为48%（95%置信区间43-53%）；白血病复发率为20%（16-24%）。改善的LFS与诊断时年龄较小和白细胞计数较低有关。这些预后变量与据报道影响化疗后结果的变量相似。这些发现表明，基于风险因素分析的治疗分配策略不太可能解决首次缓解AML移植与化疗的争议。
