Reiffers J, Gaspard M H, Maraninchi D, Michallet M, Marit G, Stoppa A M, Corront B, David B, Gastaut J A, Scotto J J
Département de Hématologie CHR Bordeaux, Hôpital Haut Leveque, Pessac, France.
Br J Haematol. 1989 May;72(1):57-63. doi: 10.1111/j.1365-2141.1989.tb07652.x.
Eighty-five adult patients under the age of 50 years with acute myeloid leukaemia (AML) were entered into a prospective controlled study conducted to compare the effectiveness of allogeneic or autologous bone marrow transplantation and intensive chemotherapy for patients in first complete remission. Sixty-one patients (72%) achieved complete remission then received a consolidation treatment. After consolidation, 58 patients who were still in remission were assigned to three different therapeutic modalities. Fifty-two patients were evaluable: 20 patients who had an HLA-identical sibling donor underwent allogeneic bone marrow transplantation within 3 months after achievement of complete remission; the other 32 patients were randomized to receive autologous bone marrow transplantation or intensive sequential chemotherapy. The actuarial risk of relapse at 3 years was 18% for the allogeneic patients, 50% for the autologous patients and 83% in the chemotherapy group. The difference was highly significant (P less than 0.0002). The disease-free survival was respectively 66% (95% confidence interval 41-85%), 41% (95% confidence interval 16-66%) and 16% (95% confidence interval 0-31%) (P less than 0.004). We conclude that allogeneic bone marrow transplantation is presently the best therapeutic approach for patients with AML in first complete remission.
85例年龄在50岁以下的成年急性髓细胞白血病（AML）患者进入一项前瞻性对照研究，该研究旨在比较异基因或自体骨髓移植与强化化疗对首次完全缓解患者的疗效。61例患者（72%）实现完全缓解，随后接受巩固治疗。巩固治疗后，58例仍处于缓解期的患者被分配至三种不同治疗方式。52例患者可进行评估：20例有HLA相合同胞供者的患者在完全缓解后3个月内接受异基因骨髓移植；另外32例患者随机接受自体骨髓移植或强化序贯化疗。异基因组患者3年时的复发精算风险为18%，自体组为50%，化疗组为83%。差异具有高度显著性（P<0.0002）。无病生存率分别为66%（95%置信区间41-85%）、41%（95%置信区间16-66%）和16%（95%置信区间0-31%）（P<0.004）。我们得出结论，目前异基因骨髓移植是首次完全缓解的AML患者的最佳治疗方法。
