Vogler W R, Winton E F, Reynolds R C, Heffner L T, Gordon D S
Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30322.
Am J Med Sci. 1989 May;297(5):300-8. doi: 10.1097/00000441-198905000-00006.
From 1979 to 1988, 82 allogeneic and 2 syngeneic bone marrow transplants (BMT) were performed in 78 patients (age range 13-49 years) with the following diagnoses: acute myelogenous leukemia (AML) (21 patients); acute lymphoblastic leukemia (ALL) (15 patients); chronic myelocytic leukemia in chronic, accelerated, or blastic phase (CML-CP, AP or BC) (25 patients); myelodysplastic syndrome (MDS) (1 patient); multiple myeloma (MM) (1 patient); Hodgkin's disease (HD) (1 patient); diffuse poorly differentiated lymphoma (DPDL) (1 patient); aplastic anemia (AA) (13 patients). Univariant analyses were carried out to determine factors of importance in predicting outcome. AML patients receiving transplants in remission had 12/19 (63%) survivors. Only one of seven ALL patients receiving transplants in remission survives free of disease, and none of eight patients receiving transplants in relapse survived. Six ALL patients relapsed. In CML, 6 of 16 (40%) patients receiving transplants in CP survive; two of nine patients (22%) in AP or BC survive. Of the 13 aplastic anemias, 8 (62%) survive. Graft-vs.-host disease (GVHD) was evaluated in 75 patients, 24 of 33 (73%) who developed GVHD died, compared to 24 of 44 (55%) who did not develop GVHD. Of the 30 patients given the combination of methotrexate (MTX) plus cyclosporine (CSP), only 23% developed GVHD, compared to 58% of those not given the combination. Interstitial pneumonia (IP) occurred in 16 patients and was fatal in 15. The introduction of daily acyclovir and weekly intravenous gamma globulin in 1985 was associated with little reduction in the frequency of IP (from 20% to 18%). However, survival increased from 21% to 47%.(ABSTRACT TRUNCATED AT 250 WORDS)
1979年至1988年期间，对78例年龄在13至49岁之间的患者进行了82例同种异体和2例同基因骨髓移植（BMT），诊断如下：急性髓系白血病（AML）（21例）；急性淋巴细胞白血病（ALL）（15例）；慢性、加速期或急变期慢性髓细胞白血病（CML-CP、AP或BC）（25例）；骨髓增生异常综合征（MDS）（1例）；多发性骨髓瘤（MM）（1例）；霍奇金病（HD）（1例）；弥漫性低分化淋巴瘤（DPDL）（1例）；再生障碍性贫血（AA）（13例）。进行单变量分析以确定预测结果的重要因素。处于缓解期接受移植的AML患者中有12/19（63%）存活。处于缓解期接受移植的7例ALL患者中只有1例无病存活，而8例复发期接受移植的患者无一存活。6例ALL患者复发。在CML中，处于慢性期接受移植的16例患者中有6例（40%）存活；处于加速期或急变期的9例患者中有2例（22%）存活。13例再生障碍性贫血患者中有8例（62%）存活。对75例患者评估了移植物抗宿主病（GVHD），发生GVHD的33例患者中有24例（73%）死亡，未发生GVHD的44例患者中有24例（55%）死亡。在30例接受甲氨蝶呤（MTX）加环孢素（CSP）联合治疗的患者中，只有23%发生GVHD，而未接受联合治疗的患者中这一比例为58%。16例患者发生间质性肺炎（IP），其中15例死亡。1985年开始每日使用阿昔洛韦和每周静脉注射丙种球蛋白，但IP的发生率仅略有降低（从20%降至18%）。然而，生存率从21%提高到了47%。（摘要截短至250字）
